Commercial without heart

Monday, December 3, 2007

In the middle of watching a football game on a Sunday afternoon, the routine commercials came and went. A beer here, a car there, but then came Cypher.

The commercial touted how well Cypher stents did in opening narrowed heart blood vessels and preventing heart attacks. Then comes the disclaimer about what side effects and adverse reactions can occur…then the clincher. Have an informed discussion with your doctor about whether Cypher is right for you. Informed discussion? About heart stents?

My perspective on informed discussions in the midst of a heart attack is limited. The patient is sick, may have low blood pressure, abnormal heart rhythms and difficulty breathing. Then there is the small matter of crushing chest pain, nurses sticking needles and monitors everywhere and an emergency doctor who says that the treatment needs to be a heart cath, where a cardiologist will put a tube in the groin, squirt dye into the heart arteries, use a balloon to open the blockage and perhaps use a stent to keep the artery from collapsing. Does the patient care if the stent model is a Cypher made by Cordis or a Boston Scientific’s Taxus? My informed discussion goes something like “You’re having a heart attack and one of the blood vessels in your heart needs to be opened. OK?” To be fair, I have a longer explanation about heart attacks, but that’s the gist of it.

As I write this, I am uncertain which stent is the preference of the cardiologists in my hospital. There are a plethora of scientific articles which may favor one type of heart stent over another, but I yield to my specialist colleagues to decide which they feel most comfortable. I rarely ask my car mechanic whether the shop uses Craftsman tools.

Perhaps there is opportunity for patients to have heart-to-heart discussions with their cardiologist if they are electively considering heart catheterization to confirm the diagnosis of coronary artery disease or heart artery blockage. I’m uncertain how the conversation would go:

“Doc, I was watching my Chargers play on Sunday and they told me all about Cypher stents and how they are the next best thing sliced bread. And a good thing to since I get chest pain every time I watch them play. So it that what I’m getting?”

No sweat if the doctor and hospital use Cyphers, but what if they use Taxus stents or a couple others in the development pipeline including Endeavor from Medtronic, the people who brought you the pacemaker. Does the cardiologist act like a new car salesman and say that he only sells Toyotas?

“Sorry doc, the commercial said that I need to be a Cypher guy. I guess I’ll check out the heart specialist in the next office building. I wonder if he offers rustproofing?”

Drug companies and medical device companies believe that it’s important to advertise directly to the consumer and that demand will increase. It very well may work for stuff that the consumer can decide upon. But heart attacks are not acne or arthritis. When you need a cardiologist, and you agree to have tubes stuck into your heart, I hope your trust includes allowing him to pick his own tools.

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