I really don’t like scolds. I have hesitated to write this short piece because it makes me seem like a scold. But I can’t help myself. This week I saw on my Facebook feed a picture celebrating the 500th implant of a preventive cardiac device. The picture featured smiling doctors and super-happy industry reps. The writer expressed happiness that they had helped so many people.
I’m old enough to remember when doctors advertised cigarettes on national TV shows in prime time. Also in full page magazine ads.
Doctors have been Big Pharma’s pimps forever. It convinced MDs that cholesterol causes heart disease so they could create the most profitable drug in history (statins).
Doctors are still being duped. They should be ashamed. But it’s just all about the money.
It’s a miracle we still have a few honest docs left — like Dr. M.
Agree. With loss of trust during the pandemic, it is more important than ever that physicians keep arms length relationships with industry and not appear to promote products. Patients count on us to be their educated consumers.
As a lay person who worked in the support side of a hospital for 29 years think we all, at least older people, I’m 67, trusted what physicians told or showed us. I had a knee replacement in 2015 due to an infection from a cortisone shot in that knee. You know how I determined which surgeon was going to perform my replacement, I talked to the physical therapists on which surgeons had the best outcomes, made the choice, it wasn’t at the hospital I worked at, and my knee has been perfect. Most people don’t have that option, that’s why we need physicians like you who can make sense of the data from studies and at least give us something to go on to make the best decisions. We need patient advocates who can cut through the crap and write the truth.
My local newspaper has a large article devoted to a cardiac surgeon bringing "new procedures" to the area. The first, hybrid maze, has been around for a long time and is not used widely because there is no evidence to support that it might be safer and/or effective than non surgical ablation procedures. The second "new procedure" is minimally invasive mitral valve repair with robotic assistance. Again, a procedure around for decades which has not been shown superior to widely available surgical approaches to valve repair which don't use robotic assistance.
A close look at the upper right of the article reveals the term "sponsored content" in tiny print. it is a PR promo for Sharp to either a) convince patients to get procedures they don't need or b) take business away from other medical systems/doctors.
Please share your detailed analysis on MitraClip and TriClip. These devices are out of control. It seems odd that 2 trials a month apart come out with totally opposite results for MitraClip (eventhough different in MR severity and LV dilatation has been used as explanation) . For TriClip the Triluminate trial is not convincing. I read your writing on these before but I would really appreciate more detailed and expansive analysis by you.
"In the past, industry had to employ key opinion leaders from academia to promote their products."
REBUTTAL: Not according to your first replier. e.g. Doctors endorsing various cigarette brands.
MANDROLA: Now, with social media, industry can make any clinician who uses a lot of their product into influencers.
REPLY: And any doctor who is sick of neurotics and hypochondriacs, or simply doesn't like people, in general, can join the INDUSTRY --- usually for more money than any General Practitioner makes, provided that they are intelligently misanthropic, and good chemists or engineers.
MANDROLA: I believe it best to resist the urge to be used. [You mean resist being used by "industry" but don't resist being used by patients, which include both neurotics and hypochondriacs. KB]
MANDROLA: Through the rise of the managerial state in healthcare, doctors are losing our status as professionals. These promotional images only accelerate the decline. JMM P.S. Many of these images also break the SACRED bond of patient confidentiality.
FINAL COMMENT: When you people broke your "sacred" Hippocratic Oaths, with both abortion and euthanasia, everything else about which you complain, logically and inevitably followed, according to Hippocrates himself --- which is why he invented/initiated the oath in the first place. Though a "scold", it was good advice despite the vast hypocrisy of modern medical "professionals".
I’m not a physician but “understanding” is that the problem is legal. If you don’t use the devise and patient has an event, patient might sue you. A physician’s lot is not an easy one.
Well said. With that in mind, I'm curious as to what your opinion is of the CardioMEMS PA monitoring system? We have added a recent faculty cardiologist who is very familiar with this system and is promoting it. I have a number of patients with HFpEF and I can't really discern if it's worth using in this population. But I'm a general internist.
Within the last couple of years I happened to reread Guy Debord's The Society of the Spectacle and Ivan Illich' Medical Nemesis in succession.
With that pairing, you can see how this can happen.
The market will use the tools of media to commodify medicine. But the market unlike real science is not an optimizing process because consumers are not rational and do not have complete information. Scientism makes it worse.
Healing and comforting the sick, the basis for medicine, is naturally intrinsical motivated. The Good Samaritan is moved to help the injured neighbor as a natural instinct of being human. He is not motivated by the external law nor performative religiosity.
But the process of spectacularization and commodification thru unbridled capitalism dangerously substitutes extrinsic motivation (money, fame and narcissistic promotion of the performative do-gooder).
Put me down in the camp that says no advertising for Rxs and all medical services.
Also all supplements labeled "this is not food and any health claims are dubious and unlikely to be true. Consult your physician."
Ten yrs ago I had a complex mitral repair at Cleveland Clinic--the valve capital of the world with great outcome stats to prove it (sorry, I'm a biased patient). The proc was a classical open-heart job, and the repairs have held up nicely for a decade. The surgeon, "while we are in the neighborhood/in your open heart," did a Maze ablation for my AFib, also with enduring, good results. The noninvasive proc was already offered but remains unproven, from what I can tell. Doctors need to halt being inadvertent shills for devices and procs that don't have results backed by evidence. As Dr. M implies, they can really do some harm.
I endorse your viewpoints. Importantly such celebrations are seen with expensive stuffs only, even though many times much cheaper alternatives could be equally good. But such alternatives are never celebrated like them.
This presumes that elevated cholesterol is indeed a causative factor in heart disease. Cholesterol is the substrate for ALL the steroid hormones -- alodosterone (fluid & mineral balance), stress & blood sugar management via cortisol, sex hormones -- not just reproduction but tissue repair & maintenance plus operations management. Testosterone is crucial for muscle maintenance -- isn't the heart a muscle? Cholesterol is the starting point for vitamin D, and the mevalonate pathway (the route statins inhibit) is also necessary for production of vitamins A, K2, and CoQ10. Cholesterol is also a key component of all cell membranes and myelin, among other roles. Focusing on one outcome is typical modern 'science-thinking', but it misses the whole picture. Maybe statins reduce risk of CVD by .5% but they increase risk for dementia, depression, homicide and suicide, cancer, diabetes, numerous other diseases, while seriously obstructing basic day to day functions. As a board certified clinical nutritionist (CCN) I studied LOTS of biochemistry with an eye to its practical implications. Weren't these basic roles covered in medical education as well? Very practically, the fat phobia mania has distracted us from the obvious. Our bodies need lipids -- fats and cholesterol -- to function. Every cell in our bodies (except mature RBCs) is capable of synthesizing cholesterol. Is this a careless oversight? When our forebears lived happily off the 'fat of the land' it's a safe bet it wasn't refined vegetable oils.
I’m old enough to remember when doctors advertised cigarettes on national TV shows in prime time. Also in full page magazine ads.
Doctors have been Big Pharma’s pimps forever. It convinced MDs that cholesterol causes heart disease so they could create the most profitable drug in history (statins).
Doctors are still being duped. They should be ashamed. But it’s just all about the money.
It’s a miracle we still have a few honest docs left — like Dr. M.
Agree. With loss of trust during the pandemic, it is more important than ever that physicians keep arms length relationships with industry and not appear to promote products. Patients count on us to be their educated consumers.
As a lay person who worked in the support side of a hospital for 29 years think we all, at least older people, I’m 67, trusted what physicians told or showed us. I had a knee replacement in 2015 due to an infection from a cortisone shot in that knee. You know how I determined which surgeon was going to perform my replacement, I talked to the physical therapists on which surgeons had the best outcomes, made the choice, it wasn’t at the hospital I worked at, and my knee has been perfect. Most people don’t have that option, that’s why we need physicians like you who can make sense of the data from studies and at least give us something to go on to make the best decisions. We need patient advocates who can cut through the crap and write the truth.
My local newspaper has a large article devoted to a cardiac surgeon bringing "new procedures" to the area. The first, hybrid maze, has been around for a long time and is not used widely because there is no evidence to support that it might be safer and/or effective than non surgical ablation procedures. The second "new procedure" is minimally invasive mitral valve repair with robotic assistance. Again, a procedure around for decades which has not been shown superior to widely available surgical approaches to valve repair which don't use robotic assistance.
A close look at the upper right of the article reveals the term "sponsored content" in tiny print. it is a PR promo for Sharp to either a) convince patients to get procedures they don't need or b) take business away from other medical systems/doctors.
Very true. Is amazing how industry is invading medicine . ( see Tricuspid valve )
Please share your detailed analysis on MitraClip and TriClip. These devices are out of control. It seems odd that 2 trials a month apart come out with totally opposite results for MitraClip (eventhough different in MR severity and LV dilatation has been used as explanation) . For TriClip the Triluminate trial is not convincing. I read your writing on these before but I would really appreciate more detailed and expansive analysis by you.
Dr. Mandrola, quote:
"In the past, industry had to employ key opinion leaders from academia to promote their products."
REBUTTAL: Not according to your first replier. e.g. Doctors endorsing various cigarette brands.
MANDROLA: Now, with social media, industry can make any clinician who uses a lot of their product into influencers.
REPLY: And any doctor who is sick of neurotics and hypochondriacs, or simply doesn't like people, in general, can join the INDUSTRY --- usually for more money than any General Practitioner makes, provided that they are intelligently misanthropic, and good chemists or engineers.
MANDROLA: I believe it best to resist the urge to be used. [You mean resist being used by "industry" but don't resist being used by patients, which include both neurotics and hypochondriacs. KB]
MANDROLA: Through the rise of the managerial state in healthcare, doctors are losing our status as professionals. These promotional images only accelerate the decline. JMM P.S. Many of these images also break the SACRED bond of patient confidentiality.
FINAL COMMENT: When you people broke your "sacred" Hippocratic Oaths, with both abortion and euthanasia, everything else about which you complain, logically and inevitably followed, according to Hippocrates himself --- which is why he invented/initiated the oath in the first place. Though a "scold", it was good advice despite the vast hypocrisy of modern medical "professionals".
Your friendly "scolding" former Lab Technologist
Kevin
Amen and amen!
BRAVO.
I’m not a physician but “understanding” is that the problem is legal. If you don’t use the devise and patient has an event, patient might sue you. A physician’s lot is not an easy one.
Well said. With that in mind, I'm curious as to what your opinion is of the CardioMEMS PA monitoring system? We have added a recent faculty cardiologist who is very familiar with this system and is promoting it. I have a number of patients with HFpEF and I can't really discern if it's worth using in this population. But I'm a general internist.
Thank you.
Within the last couple of years I happened to reread Guy Debord's The Society of the Spectacle and Ivan Illich' Medical Nemesis in succession.
With that pairing, you can see how this can happen.
The market will use the tools of media to commodify medicine. But the market unlike real science is not an optimizing process because consumers are not rational and do not have complete information. Scientism makes it worse.
Healing and comforting the sick, the basis for medicine, is naturally intrinsical motivated. The Good Samaritan is moved to help the injured neighbor as a natural instinct of being human. He is not motivated by the external law nor performative religiosity.
But the process of spectacularization and commodification thru unbridled capitalism dangerously substitutes extrinsic motivation (money, fame and narcissistic promotion of the performative do-gooder).
Put me down in the camp that says no advertising for Rxs and all medical services.
Also all supplements labeled "this is not food and any health claims are dubious and unlikely to be true. Consult your physician."
Ten yrs ago I had a complex mitral repair at Cleveland Clinic--the valve capital of the world with great outcome stats to prove it (sorry, I'm a biased patient). The proc was a classical open-heart job, and the repairs have held up nicely for a decade. The surgeon, "while we are in the neighborhood/in your open heart," did a Maze ablation for my AFib, also with enduring, good results. The noninvasive proc was already offered but remains unproven, from what I can tell. Doctors need to halt being inadvertent shills for devices and procs that don't have results backed by evidence. As Dr. M implies, they can really do some harm.
I endorse your viewpoints. Importantly such celebrations are seen with expensive stuffs only, even though many times much cheaper alternatives could be equally good. But such alternatives are never celebrated like them.
Thank you , Dr.M!
This presumes that elevated cholesterol is indeed a causative factor in heart disease. Cholesterol is the substrate for ALL the steroid hormones -- alodosterone (fluid & mineral balance), stress & blood sugar management via cortisol, sex hormones -- not just reproduction but tissue repair & maintenance plus operations management. Testosterone is crucial for muscle maintenance -- isn't the heart a muscle? Cholesterol is the starting point for vitamin D, and the mevalonate pathway (the route statins inhibit) is also necessary for production of vitamins A, K2, and CoQ10. Cholesterol is also a key component of all cell membranes and myelin, among other roles. Focusing on one outcome is typical modern 'science-thinking', but it misses the whole picture. Maybe statins reduce risk of CVD by .5% but they increase risk for dementia, depression, homicide and suicide, cancer, diabetes, numerous other diseases, while seriously obstructing basic day to day functions. As a board certified clinical nutritionist (CCN) I studied LOTS of biochemistry with an eye to its practical implications. Weren't these basic roles covered in medical education as well? Very practically, the fat phobia mania has distracted us from the obvious. Our bodies need lipids -- fats and cholesterol -- to function. Every cell in our bodies (except mature RBCs) is capable of synthesizing cholesterol. Is this a careless oversight? When our forebears lived happily off the 'fat of the land' it's a safe bet it wasn't refined vegetable oils.