Medical ads aim straight for the heart

By Bruce Japsen
Tribune staff reporter
http://www.chicagotribune.com

An outcry over ads nudging consumers to ask their doctors for purple pills, depression remedies or other brand-name prescription drugs hasn’t stopped an escalation of direct-to-consumer marketing in health care.

In fact, as spending on such ads continues to climb, a new television commercial has introduced an entirely new category in the mix. Now showing: TV ads aimed at consumers touting a $30,000 heart defibrillator that must be surgically implanted.

Medtronic Inc., maker of an implantable cardioverter defibrillator, has launched a national $100 million campaign to raise awareness of sudden cardiac arrest. The blitz includes marketing materials for physicians and also television and print ads directed at consumers–representing a shift away from doctors initiating the discussion about such devices.

Executives at companies like Medtronic say that advertising new procedures as well as prescription drugs direct to consumers imparts valuable information and potentially saves lives.

“This is about trying to save more lives,” said Dr. David Steinhaus, vice president and medical director of cardiac rhythm disease management at Medtronic. “There are people dying every day because they are not protected and they do not know they have a problem.”

But critics say ads like Medtronic’s campaign for its defibrillator could lead to a new burst of spending on medical care, just as the barrage of prescription drug ads has been blamed for part of the increase in health-care costs to employers and taxpayers.

Since 1998, the year after the FDA eased restrictions on consumer drug ads, spending on brand-name drug advertising has quadrupled to more than $4 billion a year and some insurers have reported their prescription cost increases have gone up by double digits under the more lax FDA rules.

“The industry is now pushing the envelope on even implantable devices,” said Dr. James Rohack, an American Medical Association board member and Texas cardiologist who saw a Medtronic TV ad last week. “You need to have a good discussion with your doctor before you go down that road.”

Some say it could spur unnecessary and expensive surgeries if worried heart patients demand doctors implant such a device. Physicians fearful of malpractice suits may find it hard to deny patients what they ask for.

Drug legislation on way?

The new wave of drug and device ads comes as the new Democratic-controlled Congress is expected to hold hearings and potentially introduce legislation regulating the advertising of prescription drugs, which continues to grow. Congress is particularly interested now that the Medicare program offers a popular drug benefit.

Spending on consumer drug ads rose more than 8 percent, to $3.3 billion, in the first nine months of 2006, according to TNS Media Intelligence, which tracks such marketing.

The AMA has long criticized prescription drug ads that target consumers, saying they create demand based on wants instead of needs. Rohack said the association more recently has taken notice of the introduction of device ads, such as one recent campaign for an artificial hip endorsed by golfer Jack Nicklaus.

While devicemakers have traditionally limited their advertising to trade journals targeted at physicians, market research firm Cutting Edge Information said consumer ad spending on medical devices grew to nearly $50 million in 2005 from practically “nothing” a decade ago.

Medtronic believes its campaign is the first for a heart device, in terms of reaching out to consumers.

Executives at Medtronic, the Minneapolis-based maker of a variety of heart devices, said the ad campaign is designed to reach 850,000 people in the United States the company believes would benefit from a defibrillator, arguing that neither consumers nor physicians are fully informed about the device or its benefits.

Informed decisions

Most people don’t know the difference between cardiac arrest and a heart attack, Medtronic says.

Unlike heart attacks that arise when a plumbinglike problem develops in the heart from clogged coronary vessels, cardiac arrest is considered more like an electrical problem: The rhythm of the heart goes haywire, leading to sudden cardiac arrest, cardiologists say, and a quick death.

The Medtronic device–which can cost $20,000 to $30,000, not including the cost of surgery and hospitalization–shocks the heart back into rhythm.

In the campaign, dubbed “What’s inside,” a soft voice tells viewers they will find inside the device “10,000 more kisses … 200 more football wins,” saying it will “always be there for you–close to your heart with the power to restart it in case of sudden cardiac arrest.”

Dr. Sidney Wolfe, head of consumer group Public Citizen’s Health Research Group, said he considers the ad highly misleading.

“This is trying to frighten people and you are going to have people who are scared and uniformed saying, `Let’s not take a chance,'” Wolfe said.

Similar to the way it handles drug ads, the FDA said it does not pre-approve advertisements for devices. When it comes to devices, the agency said it has “a very small unit in our compliance area,” to review device ads, agency spokeswoman Karen Riley said.

Sales slowed after recall

Medtronic’s ad blitz comes with sales growth slowing in the $5 billion defibrillator business since some models were recalled in 2005 by a Medtronic rival. Industry defibrillator sales that had been rising 15 to 20 percent annually before it slowed to flat growth last year.

Cowen & Co. expects defibrillator sales to increase nearly 6 percent this year, to $5.85 billion, compared to the investment firm’s earlier 2007 forecast of 3.6 percent growth, to $5.73 billion, due in part to the Medtronic campaign.

Those questioning campaigns like the one from Medtronic say the issue is that they do not discuss other potential options, including those that could be less expensive or less risky to patients, such as medication.

“It would be more fitting to have all aspects in the ad and say, `By the way, here are all of the treatment options that should be considered and discussed with your physician,'” said Dr. Stanley Borg, chief medical officer for Blue Cross and Blue Shield of Illinois.

But Medtronic says the ad strongly encourages patients to see their doctor and includes a toll-free telephone number in the consumer ads and pieces aimed at doctors.

“Our purpose in this advertising campaign is to get the conversation going,” Steinhaus said.
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