As regular readers of my takes on the medical-device industry might remember, I haven't been a fan of Boston Scientific (NYSE:BSX) since . well . forever. Though some of the names and faces have changed over the years, I've never been comfortable with its approach to growing its business or dealing with shareholders and regulators.

Take the most recent large example -- the acquisition of Guidant. Boston Scientific went to great lengths to make this deal happen, including offering a helping hand to Abbott Labs (NYSE:ABT), a would-be rival in drug-coated stents. The company paid a high price to buy its way into a market that is slowing appreciably right now -- and ruled by Medtronic (NYSE:MDT), which may be one of the best-run medical technology companies around.

The challenge now facing Boston Scientific isn't exactly minor. The company must reignite growth in the drug-coated stent business in the face of major competitors. It must resolve quality issues within the Guidant ICD business, and not only regain physician trust, but also cope with a newly tough market. It must also operate under the pressures of a large debt load and heavy dilution, both of which should make further acquisitions difficult (if not impossible) for some time to come.

As you might expect, this quarter was massively affected by the close of the Guidant deal. Reported revenue rose more than 30%, but would have been up only about 1% without Guidant. And while operating income did fall considerably, even when you exclude the merger costs, I think there was too much going on in this quarter to make the year-ago level a really fair comparison.

Despite the problems, this should be a real value opportunity. New drug-eluting stent technology from Guidant could be a real boost to Boston Scientific. And if the company can clean up the ICD problems, I believe it will benefit from the eventual recovery and attractive long-term growth potential of that industry as well.

Unfortunately, I have a hard time trusting management's decisions. CEO Jim Tobin talks about how investors should be comfortable with Guidant because he "looked under the hood and kicked the tires," but why should that comfort me when I think he's shown himself to be a mediocre mechanic at best? Though I can certainly see how Boston Scientific may be undervalued and underestimated today, it won't get the benefit of the doubt in my book until I see real progress.

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Fool contributor Stephen Simpson has no financial interest in any stocks mentioned (that means he's neither long nor short the shares).