What’s Inside?

I, TBTAM the Marvelous, the disciple of the famed Carnac the Magnificent, can see into the future of American Healthcare. In this envelope I hold the answer to all questions. You need only ask and I will reveal…

Ah, Dr Wes, my cardiologist colleague – You say that Medtronics’ direct-to-consumer campaign for the Implantable Cardiac Defibrillator is giving you angst. You ask the Great One to predict whether this will change the way you practice medicine…

Well, take that stethoscope out of your ears and get that guidewire ready, my systolic-minded friend. Because from what I see, Medtronic has done all the right things to assure that your practice will never be the same again.

Medtronics’ Ad Campaign

That’s their Website ad up there. The campaign is called “What’s Inside?” It’s a catchy slogan, both a question and a play on words. What’s inside your body? What’s inside that device? It’s cute. I like it.

And speaking of cute, how about that ICD device itself? It’s sleek, small, and very high tech – I’ve never even had a heart attack, and I want one. In fact, it reminds me of an IPOD or a cell phone. (Do you think it comes in colors? Can I get skinz or ring tones for mine? )

How about the commercial? It’s brilliant, that’s all I have to say. (You can watch it on the web site, just click on the word commercial there). I get all warm and fuzzy when I watch it….

Inside this little device, you may just find…10,0000 more kisses. Snow. 200 more football wins. This is an implantable cardiac defibrillator, a device that’s always there with you, close to your heart, with the power to restart it in case of sudden cardiac arrest, one of the nation’s leading causes of death…

“Close to your heart”. Like your wife, and your grandkids, and your hometown football team. Inside. Close to your heart. It works for me. And for some reason, I’m getting thoughts of Winnie the Pooh. Don’t ask me what in that ad is doing it, but it’s undeniable. When I watch that commercial, I think of Winnie the Pooh.

But wait, I’ve left the best for last. Because at the end of the commercial, after the usual disclamiers and warnings, here’s what Medtronics promises…

An ICD could give you many more bedtime stories, tons of hugs and one more thing (Are you ready, Dr Wes?It’s three little words that will change the way you practice medicine forever..) …PEACE OF MIND.

That’s right. I almost didn’t believe it myself, but there it was at the end of the commercial, and on the banner at the Metronic website. In a marketing move swiped straight from the Digene’s HPV Playbook, Medtronic is selling peace of mind as an indication for their implantable defbrillator.

And so, Dr Wes, TBTAM the Magnificent now knows exactly what you are in for. (Plus, I have confirmed it on my Ouija Board. ) I would love it if I were wrong, and only time will tell, but here are my predictions…

Sometime in the Next Few Years…

1. Patients will start calling and coming in to their cardiologists asking if an ICD is right for them. Wives will come with their husbands because the men won’t really want to ask themselves. You will feel torn. You hate sudden cardiac death as much as your patients worry about it. You may even worry about it a bit for yourself. But you also know that ICD’s are not benign devices, and have risks. You do your best to help your patients weight those risks and benefits. This will not be easy, especially if Medtronics acts like Digene, and starts to coach patients on how to convince you they need that ICD for their Peace of Mind. You will stay strong and try to do the right thing.

2. Medtronic will partner with patient arrythmia advocacy groups (or create them if they don’t already exist). These groups will need a catchy name like “The Campaign the End SCA -Sudden Cardiac Arrest”, a celebrity or survivor spokesperson and a mission. Soon, everyone in America knows exactly what Sudden Cardiac Arrest is, and what an ICD can do for them. Some good will actually come of this, because ICD’s can be lifesaving, we all know that. But many patients will be confused by this information, and many many more will start to worry…

3. When cardiologists raise concerns about the potential for overuse of ICD’s, Medtronics will agree with them and promote the use of T-Wave alternans to better predict who needs the defibrillator. Fortunately, Medtronic either makes their own T-wave alternans or partners with a company who sells this device.

4. Legislation will need to be passed mandating coverage of ICD’s and T-wave Alternans on demand, regardless of indication. No problem. Medtronics will “partner” with some government lobbying group with a benign sounding name like “Women in Government” and get that legislation passed asap.

5. A few business-saavy cardiologists will make a fortune running a chain of drive-through ICD Centers implanting on demand. Most cardiologists, however, will continue practicing evidence-based cardiology, and will offer ICD’s to patients based on real indications, and not just peace of mind.

6. Tom Cruise will leave the Church of Scientology, get an ICD implanted for his Peace of Mind and become Medtronic’s spokesperson. Demand will soar.

7. The first doctor will get sued for declining to refer for an ICD. The story will run on 20/20, be picked up by Reuters and hit all the papers. The use of ICD will increase exponentially as cardiologists everywhere try to avoid a lawsuit. Medtronic stock will hit an all-time high.

8. Cardiologists everywhere will get sued for complications related to implanting the device or misfiring of the device. These stories will not get much newsplay. Malpractice rates for cardiologists will rise higher than those of obstetricians.

Welcome to my world, Dr Wes.