Starting this coming week, television viewers will be treated to smiling faces, soothing narration and cheerful melodies in ads about ... sudden cardiac arrest....brought to you by Medtronic, Inc., the world's largest manufacturer of implantable cardiac defibrillators (ICDs) - those devices that treat rapid, potentially life-threatening heart rhythm abnormalities in people with weakened hearts from prior heart attacks or other causes. $100 million in ads. With this initiative, Medtronic is talking a card from the pharmaceutical industry: betting that direct-to-consumer advertising can boost sales of their devices. The feel-good nature of these devices that have the potential to treat arrhythmias painlessly with pacing protocols or deliver a powerful 800-volt shock to the heart to restore someone's heart rhythm back to normal will be awe-inspiring:
"10,000 more kisses...200 more football wins...An ICD could give you many more bedtime stories, tons of hugs, and one more thing -- peace of mind."But in reality, these devices are surgically implanted and are a big deal for the recipient to receive. Certainly they can mean peace of mind in some folks, but the variable psychologic impact of these devices should not be underestimated. I would say the majority of patients I have implanted with these devices are genuinely happy they have one. But there are also patients who have had unfortunate experiences with these devices: from their implant to their follow-up after recurrent shocks from the device. Sugar-coating the implications of a device implant with sexy TV spots might win people's initial acceptance, but a dose of reality and the implications for continued follow-up and management of these devices should also be reviewed carefully with the implanting physician.
One of my teaching aides regarding the "Top 15 Questions" about automatic defibrillators can be found here. It's a no-nonsense way to learn about the real issues regarding defibrillators, the surgery, and even pictures of what the chest looks like after one is implanted.
I know, I know: I should be happy ad campaign is taking place. After all, it means I'll have more business, right? But the "direct to consumer" nature of these ads removes the doctor-patient interaction in favor of the medical device industry-to-patient interaction. I find this objectionable for it limits my opportunity for an objective, unbiased discussion with my patients at an emotionally-charged period in their life. How will these ads effect my discussions with the family of a loved one who really doesn't qualify for such a device, even though their heart is weak? Will the family object to losing those "10,000 more kisses?"
I'd be interested in hearing what patients and doctors think about this upcoming ad campaign. I am reluctant to act as a drug rep for the device industry on this one - but I'll stand behind the data that these devices can save lives in patients with heart disease from certain congenital heart abnormalities and in patients with markedly weakened heart muscles - irrespective of cause - and will be the first to implant them when medically indicated.