Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.
Tuesday, January 16, 2007
OK, it's official: what little is left of my mind is now totally blown. In today's New York Times is a full page ad for ICDs (implantable cardiac defibrillator), and it's aimed straight at the consumer. I've gotten used to the ubiquitous ads for every prescription medication in the book; which is not to say they don't annoy me anymore. It's just that I've descended into a sort of overload that allows me to ignore them. Plus, in my bailiwick of the medical barnyard, it's rare to have a patient request a particular medication (other than the "this pain medicine yer givin me ain't fer shit" trope.) But this, this really is something.
"532 Candlelight Dinners; 4,354 Blissful Moments; 687 Walks in the Rain," it lists. Never mind that it sounds like a pathetic ad in the personals section of a book review mag (not that I read them.) It goes on to say "...ICD can give you more time to do the things you love with the people you love. You see ( getting very close and sensitive, maybe trying to whisper in your ear), an ICD is the most effective way to protect you from Sudden Cardiac Arrest (Capitalized!)" It goes on to give a handy website for more information, and suggests (how could you not, after all that?) "then talk to your doctor."
Sudden Death!! Gol' Dang, what 'er we waiting fer?? Maggie! Fire up the ol' buggy, we're headin' to town to talk to Doc Andy and get us one of them things. Got no time fer no website, even if'n we had onenna them 'puters.
Well, I suppose they're aiming higher: they put it in the NYT, after all.
The hell of it is, it must work: it certainly seems to with drug ads. But a heart operation? We're not talking Viagra here (if your heart-shock lasts more than four hours, seek immediate medical attention.) Hard-hearted?
I suppose the thought is that not everyone who's had a heart attack is being advised to get an ICD, and the reason must be that doctors are circumspect enough that they need jogging from their patients. "You mean you don't care if I ever walk on a beach at sunset, Doc? No more nookie, and you don't care?" Damn the odds and indications! We can sell these things if we just get people to want them. Like surround sound. "Just because" is a reason, if properly fortified with scare tactics. It's a huge insult to physicians, for one thing. And to the target audience, whose emotions, they figure, are pretty easily manipulated.
But what really bugs me is that I never thought of it myself:
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Welcome to the miracle of marketing. You don't think that deodorant just sells itself, now do you? First you have to convince people that THEY STINK.
I moved to a much bigger town after 4 years marooned in a tiny one. I was amazed at the sales tactics of a new dentist. Apparently people are just not needing restorative work like they used to and the money's in cosmetics. Dermatologists aren't just the people to see about that pesky rash anymore--they're the gatekeepers to a dip in the fountain of youth. It's all about the spa experience now.
I think we're living in an Extreme Makeover nation. God forbid anybody actually accept age-related changes or (gasp) their doctor's opinion on what they actually do or don't NEED. It's all about the wants. Kinda scary to think about the manipulation behind it; you would really think somebody would have an ethical problem with it...and you would be wrong.
Haha. That's a great idea. A $50,000 ICD that's not indicated and that the patient's insurance will not cover.
The only people who fear information are monopolists--like physicians. Yes, healthcare consumers who ask for specific treatments may be a pain to doctors (read--they take up more time and thus cost doctors money). HOWEVER, that's not the issue. The issue is whether more people who need a procedure/drug will get it. If even one person gets a pacemaker-thing who wouldn't otherwise due to DTC, isn't worth it?
you doctors are so wonderfully ethical and professional, you would never allow a patient to PRESSURE you to something that would hurt his health. Thus, DTC can only help.
Actually, the opposite could be true. Give people the idea that they want a $50,000 dollar device implantation, make it emotional, and one way or another they'll get it. Some docs, of the same mind as those who ran the ads, will find a way to justify it. I'm surprised the previous anonymous didn't think of it, given the jaundiced view of doctors. Did I say jaundiced? Say, wanna buy an operation?
Well, if it's true that doctors are such patsies, why should we have any credentializing requirement--giving you doctors all that market power and extra money.
The reason we have barriers to practicing medicine is, inter alia, doctors are supposed to have ethical standards. If many don't--as Sid avers, we should treat medicine like any other business.
Medicine IS being treated like a business, and look where that's getting us!
But trying to get back on point here: physicians above all want patients to have information, from the broadest range of reliable sources. To think that the company that makes the device and is willing to spend a hundred million on ads to consumers is the best source, is to be credulous, at best.
I can't find the ad itself. Are you sure it wasn't for an AED (automated external defibrillator)? Because I could see a market for those.
from a patient point of view, I happen to agree with the position Dr Schwab is taking. While I am a healthy (no pun intended) cynic when it comes to physicians inherently having the patient's best interest at heart, I find that direct-to-consumer advertising by pharmaceuticals and medical device manufacturers to be inappropriate at best and harmful at worst. Mainly because it is reducing the patient to a consumer and medicine to a business; Neither of which is a good thing. While many may scorn the moniker of "patient" it embodies a sacred and protected relationship between a doctor and a person; a protection that is not provided to a "consumer", "customer" or "client". I never want to be a doctor's customer; I refuse to give up my rights that are defined when I become his or her patient.
There are so many philosophical and moral violations in the DtC approach of patient "education".....from perpetuating the idea that death can be avoided if a person is rich enough or buys enough of the right things to advocating a "quick fix" scheme that eliminates personal responsibility for health maintenance and disease prevention. And yes, these ads ARE derogatory to the ethics and codes of the medical profession, rules of conduct that patients shouldn't be scorn out of hand.
To those that pursue capital gains as the epitome of success and happiness, the idea of doing the right thing because it is the right thing to do is inconceivable. There is a reason that medicine does not proclaim"caveat emptor" rather than "primum non nocere"
The best is yet to come....watch for the TV spot to air repeatedly over the next month or so, then the deluge of more print ads...
Medtronic wants to take the "high road" of the "disseminating information" about ICDs' life-saving advantages in their ads, but are their motives really in the best interest of patients when risks, complications, and even the mechanics of implantation are not delineated? The information disseminated is a form of marketing propaganda that neglects important issues related to ICD implantation. Certainly, if "one more person" is saved by DTC advertising - wonderful - but that one more person also made an implanting doctor richer because he got to bill for the procedure. Doctors must be careful to implant these devices because they are indicated, not because of an emotional bias injected by a feel-good, sugar-coated ad by the manufacturer of the device. When money is involved (and these devices cost LOTS of money) it's a slippery slope to inappropriate device implantation.
BTW, to suggest that physicians are "monopolists" with the availability of information of the internet demonstrates a miopic vision of medicine today.
Scalpel: not sure if you're being facetious (with respect to a comment I decided to delete) or not. The ad is for ICD: it even shows the little bugger. Front section of today's NYT.
Anonymous (one of them): I'm ok with disagreement. I'm NOT ok with gratuitous insults. Which is why one of your posts is now gone.
And geez: isn't anyone going to mention my ad?
That's it Sid, sign me up for one of those Choledochojejunostomy NOW!
No doctor, I really think I need this.
C'mon doc, I just want to live with a clearer view of life! And everyone says this choledo-something will make that better!
Look doc, if you get me this, you and I both benefit - c'mon! And if you won't give it to me, you know Dr. Wantmimoney down the street will.
I wasn't being facetious, I really never saw the ad (and in agreement with you I find the idea of an advertisement for an ICD bizarre and inappropriate - thus my confusion). I think having an AED in the back of the minivan wouldn't be a bad idea, however.
Even better than the print ad is the TV commercial. I've seen it several times in the last few weeks.
To make people get in line for a choledochojejunostomy, all you have to do is say it causes weight loss. You'll be busier than a one-armed paper hanger.
Well, the last thing I want to do is upset your precious sensitivity, Sid. (This is the Anonymous you excised, ahh, but you surgeons love to cut and maime-- oh, I'm sorry, I didn't mean to upset you. I hope you have some smelling salts handy).
Most of these comments are baffling. They assume people are so stupid as to demand surgeries they don't really mean and that doctors--who are supposed to be so ethical and stuff--are powerless to say "No."
It would help your argument, Sid, if you could point to ANY evidence that DTC has harmed health. You can't. In fact, the evidence I've seen has shown that at least for getting people to the doctor for depression, DTC has been very effective and beneficial.
Otherwise, I think DTC bothers doctors simply because it can make patient interactions longer, and thus cost doctors money. Need that extra Lexus, I guess.
IN the end, Sid, you never asked my question: if one person who wouldn't otherwise get an pace maker thingy (and need it) gets one due to ads, isn't all the extra time worth it--or is that third Lexus more important to you?
Anon: I'd be more inclined to answer your questions if they weren't laced with such hyperbole. I'm actually able to have discussion without hurling insults; in fact, I prefer it. So come on back when you've taken a deep breath.
In 10 years they'll be marketing them for your pets!
Interesting timing, as my discussion group was all about Big PhRMA today. And is this ad for real?
This sort of DTC advertising is banned in Canada as of right now, but CanWest Global sees a cash cow and is currently pushing to be allowed. And of course we get lots of American channels anyhow.
Patients even here come with a preconceived notion of what they have (actual conversation with a parent: "it's her liver, doc, I examined her myself." "fair enough but errrr the liver is on the other side.....") and often enough what they want to take for it. Not occasionally due to PhRMA's *ahem* 'awareness raising' activities.
Isn't it bad enough that PhRMA markets to us, the medical profession? Isn't it bad enough that we, who have been trained in how to sift through all the studies with a jaundiced (help!!) eye, have to do that without some person who has fantastic training in some other field (or not as the case may be) but not in critical appraisal of medical literature suddenly convinced by claims in the large type of an advert that their life is an ICD-deficiency state, coming to us in utter panic?
Ack. Rant over.
pI suspect that Medtronic isn't simply trying to convince a person to get this device, when he/she doesn't need it.
It may be that if a patient is told that they truly need this type of implant, that the patient will perk up and say, "Well then, I want a Medtronic!" Rather than leaving it up to the cardiologist to decide which company's implant to use. Of course, I'm assuming that there is more than one maker of this type of implant.
For at least a year now, I've been seeing TV ads for artificial hip and knee joints. Thanks to these ad campaigns, I'm now familiar with the brand names Biomed, Stryker and Zimmer. Next time I need a joint replacement, I'll know just which brand to ask for.
MMM: It's possible. But I'd be more convinced if the ad weren't all about more days, walks in the rain, etc (there were many more such items in the ad); it seems to be trying to get people to demand the device.
And I wonder: do you really know enough to request a particular hip prosthesis, based on ads? Enough to refuse if your surgeon has reasons for choosing a different one? I don't know. The kind of surgery I've done all my career doesn't involve prosthetics: but if I were having a hip replacement, I'd want my surgeon using the hardware with which she's most familiar and comfortable. It's not like an oil filter when you can take your pick. Each prosthesis has different methods of implantation, and different tools with which to do it. The ads don't mention that. But why would they?
Medtronics has copied striaght from the playbook of Digene's HPV comsumer campaign. They are suggesting that what the ICD gives is not just more kisses and hugs but "peace of mind". That's the new mantra for medical necessity - peace of mind.
Do you think we will be getting an ICD-9 code for that indication anytime soon?
Lost in these conversations and advertisements is what actually happens when these things work as designed. One shock is enough for many people to beg for their removal. Imagine lying as still as possible on a stretcher (so as not to do anything that might upset the monster) after your 20th consecutive shock in under an hour. Paralyzed with fear, anticipating the next one.
"Please help me, doctor.... AAARRRRRGH!!!!!"
It isn't pretty. Is it better than death? Maybe.
Wow - that's marketing for ya.
I just saw the same ad in today's local paper (Minneapolis, Medtronic's hometown). Shameful.
The Medtronic ad has been all over the TV here in the D.C. area for two to three weeks now. Disgusting.
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