MEDICAL MARKETING: N.Y. Times Explores Ethics
Today's New York Times takes a critical look at the aggressive promotional tactics of medical device manufacturers targeting interventional cardiologists at the annual Transcatheter Cardiovascular Therapeutics meeting. "For about five days" every fall, the Times reports, interventional cardiologists from around the world convene in Washington, D.C. to learn about the latest methods and devices used to open blocked blood vessels. There they are flooded with information from interventional device companies who spend millions on "elaborate display[s]," gifts for physicians, closed- circuit television presentations and sleek sales pitches. "Often, the treatments described in the medical conference surge into general use," the Times reports, without studies to back their usefulness over conventional therapies. As a result, many leaders in interventional cardiology worry that "heart patients may find themselves being treated with expensive devices not because they have been shown to be the most effective but because they were intensively promoted."
Critics express concern that the Transcatheter Cardiovascular Therapeutics meeting violates the American Medical Association's voluntary code of professional ethics by "allowing companies to spend lavishly on doctors they are wooing and to select speakers for sessions discussing their products." In addition, unlike most medical conferences, the educational sessions are not kept separate from the industry-sponsored exhibit hall, and products are mentioned by name. "Such talks, in which devices are named and praised, are unheard of at scientific meetings held by groups like the American Heart Association," the Times reports. Dr. Jeffrey Brinker, chief of interventional cardiology at Johns Hopkins University School of Medicine, said, "The thing that stands out [about the conference] is the blatantness."
Tried And True
Dr. Steven Nissen, vice chair of cardiology at the Cleveland Clinic, said, "This isn't just a minor problem in medicine. It affects hundreds of thousands of patients and the whole way interventional cardiology is practiced." The Times reports that some of the devices initially hailed at the conference, such as lasers and plaque-shaving miniature whirling saws used for directional atherectomy, have been all but discontinued after clinical trials concluded their risks outweighed potential benefits or doctors found their performances did not live up to their promises.
Time To Compete
Critics point out that in recent years, as the number of cardiologists has outstripped market demand, "doctors have sought to remain competitive by offering the newest and most exciting treatments." In addition, medical device companies often pay "$1,000 to $5,000 per patient" to doctors who participate in clinical trials of the latest treatments and often reward long- term customers with places in the trials.
One prominent cardiologist, who "insisted on anonymity," said that the "atmosphere at the recent meetings was so enthusiastic that those expressing caution were dismissed." When he asked for "evidence that a device that shaved plaque from arteries was superior to standard treatments," he said the response was, "Are you crazy? Come on. Everyone's doing it. It looks so good that we can use it for 80 percent of our cases." He said, "It's one big infomercial."
Abuse of Power?
Dr. Martin Leon, the cardiologist from Washington Hospital Center whose Cardiology Research Foundation sponsors the meeting, argues that "the event helps doctors keep abreast of changes in their field." He said, "If you are a practicing interventionist, you have an opportunity to see every conceivable product or device that you might use on one of your patients. The meeting has grown to such a point where it puts us in a position where we can have an influence" on the practice of medicine. The Times reports that he added he hoped this influence "is not interpreted as an abuse or exercise of power" (Kolata, 2/10).