Tag Archives: Advertising

Getting To The Heart Of Father’s Day

The skeptical cardiologist received an email from the folks at AliveCor a few days ago with the subject line:

Dad’s heart matters – Kardia Mobile for Dad will give you peace of mind and make Dad happy

The email contains this image of an older well-dressed man (withScreen Shot 2016-06-18 at 9.03.26 AM lots of bling) standing in a beautiful meadow near the ocean. The man has decided to turn his back on the ocean and check his heart rhythm using the AliveCor/Kardia (AliveCor has changed the name of its ECG devices to Kardia) mobile ECG. This man is a happy dad! (Unless his heart rhythm is interpreted as atrial fibrillation. Then the beach walk is ruined.)

The email asks the question “What if Dad’s heart really was an open book?”

Uhh, he’d be dead? Clearly books don’t function well at pumping 5 or 6 liters of blood through the cardiovascular system every minute whether they are open or closed. Perhaps  the question is using either  the heart or an open book as a metaphor?

The advertisement goes on to suggest that I get my dad an AliveCor device for father’s day  “So you always know what his heart is thinking.”

I believe this is the marketing person’s attempt to extend the metaphor of the open book, i.e., you know exactly what dad’s brain is thinking, now you can extend this knowledge to his heart.  The metaphor of the heart “thinking” is quite poor but poor metaphors are the norm today.

Bad metaphors and bad writing abound on father’s day because 90 million greeting cards are purchased and given as (according to the Greeting Card Association)  “a meaningful expression of personal affection for another person.” Despite the increasing use of Facebook and its ilk to transmit emotions, the Greeting Card Association assures us that “The tradition of giving greeting cards … is still being deeply ingrained in today’s youth, and this tradition will likely continue as they become adults and become responsible for managing their own important relationships.

Mobile Ecg Monitor As A Father’s Day Gift

I have to say that despite the horror of the writing in this email advertisement it got me thinking about getting my father a Kardia device. I’ve suggested  previously that  an AliveCor device would make a good gift for Christmas for a loved one who has intermittent unexplained palpitations or atrial fibrillation but had not considered this for my dad.

For one thing he does not possess a smart phone which is required to  make the Kardia device functional. For another, he doesn’t have atrial fibrillation (that we know of. Perhaps if I knew what his heart was thinking we would find out that it likes to fibrillate late at night,)

Perhaps it’s time to upgrade my Dad to an iPhone I began thinking.

But wait! He has an iPad mini (that he seems to only use for FaceTime conversations.)

Further research reveals that Kardia is not only compatible with iPhone and Android smartphones but apparently iPads and IPod Touch.Screen Shot 2016-06-19 at 8.04.27 AM

Taking Care of Dad’s Heart

What about the rest of the slick advertising copy in my email?

And now you can know the way to help take care of it. Kardia gives Dad a medical-grade EKG in only 30 seconds. It even gives him expert analysis and tracking, with reports getting shared directly with his physician

This part is pretty clear and correct. I use Kardia daily in my office to record patient’s heart rhythm and I have a dozen patients now who make recordings outside of the office. They can have their recordings read by a random cardiologist for a fee or establish a link with me as their provider and I can review them through my account for free.

 Is It The First Father’s Day Gift That Leads To More Father’s Days?

The ad ends with the remarkably brazen statement that “It’s the first Father’s Day gift that leads to more Father’s Days.”

While I find the device more helpful in many instances than current expensive and intrusive long term monitoring devices for detecting and monitoring atrial fibrillation and other abnormal heart rhythms, it is a huge leap to suggest that this translates somehow into a longer life span.

To AliveCor’s credit, despite such ridiculous marketing drivel , studies presented at the recent Heart Rhythm Society Scientific Meetings suggest:

  • Kardia Mobile Superior to Conventional Monitoring: Researchers at the Leeds General Infirmary found that the AliveCor monitor is superior to conventional Holter monitoring in patients with palpitations, providing a higher diagnostic yield, more detected arrhythmias, with a similar workload.

  • Kardia Mobile Leads to Improved Patient Compliance:Researchers at the University of Buffalo found that AliveCor provides a diagnostic yield comparable to a 30-day ambulatory looping event monitor and that the smartphone-based ECG monitor can be used as a first approach for the diagnosis of palpitations.

  • Kardia Mobile provided more information resulting in changes in arrhythmia patient management than traditional external event recorders in a study from researchers at the University of Miami.

  • AliveCor’s AF algorithm was reported to be superior by researchers at Arizona State University to the patient’s own ability to detect AF via symptoms.

    But even if these studies make it to publication they don’t suggest the device provides any improved longevity. In fact, such data, do not exist for any monitoring device.

Happy Father’s Day, Dad! Don’t be surprised when we FaceTime later today that I’ve found another use for your iPad.

Paternally Yours,


N.B. Clearly I receive no consulting, speaking or P.R. writing fees of any kind from AliveCor. Nor do they provide me with any free devices. What’s more, when I lose one of their devices they don’t replace it.  I am totally free of any conflict of interest.


Cardiology Marketing: A Plea For Honesty and Scientific Accuracy

In the last few years the skeptical cardiologist finds himself inundated and sickened by slick promotional material from various hospitals across the country. These pamphlets typically tout the cutting edge research being done or the latest surgical and catheter-based techniques that the cardiologists at their facilities are doing.

Obviously, a lot of marketing energy and money is being expended by hospitals in an effort to lure patients away from their normal referral hospitals to come to these hospitals located in cities like Cleveland, Baltimore, Los Angeles and New York.

It is my sense that the doctors who are featured in these print infomercials either don’t proofread the advertising copy or they are shamelessly engaging in overhyping procedures that are, at best, marginally better than those available in the community.

Robots For Heart Surgery

Let’s take the latest example I pulled from my office mail which is the “Cardiovascular Report” from Johns Hopkins Heart and Vascular Institute.

Each article in the four page glossy pamphlet, comes replete with a large color picture of a photogenic doctor who looks incredibly earnest and dedicated.

Each article begins with an anecdote which has become a staple, it seems, for all medical reporting. We learn of a specific patient who had a particular cardiology problem. After bungling by the local doctors, the patient is very fortunate to have been referred to Johns Hopkins where cutting edge knowledge, elite cardiologists, and often a new surgical or catheter-based procedure dramatically effected their outcome.

Although the story of one patient makes for dramatic reading and human interest, patients should never make decisions on what procedures to do based on such anecdotes.

The story entitled “An Ideal Candidate for Robotic-Assisted Mitral Valve Repair” begins with an anecdote about Jim Watkins of Overland Park, Kansas who knew he had a heart murmur and was diagnosed with “benign mitral valve prolapse” and told by his cardiologist “not to worry about it but to have a follow-up every three years or so.”

The article implies that such a conservative approach was foolish, but the vast majority of mitral prolapse patients with less than severe leakage from their mitral valves are best managed this way. One of the major criticisms of cardiologists is that we perform too many tests too frequently.

A routine echocardiogram (heart ultrasound) revealed “moderate-to-severe mitral valve leakage and marked leaflet regurgitation.”  This phrase could not have been proofread by a competent doctor because mitral leakage and regurgitation are describing the same thing. The story quotes the patient as saying that “they wanted me to have open-heart surgery before Christmas.”

Assuming that Mr. Watkins was free of symptoms at this point, and that the function of his left ventricle was normal, there would be no reason to rush into surgery for moderately-severe mitral regurgitation.

The patient began exploring options and “learned that minimally invasive robotic repair was an option that offered faster recovery and minimal scarring.”

I’m pretty certain he learned all the positives of the technique from a website like that of Johns Hopkins, Cleveland Clinic or Mayo Clinic, who specialize culling the best mitral repair candidates from the population across the United States.

The articles then states “The Midwest hospitals that could do it, however, had months-long waits.” I find this statement totally unbelievable. I know that the longest wait I have ever noted for such surgery in St. Louis is about a week.

The article goes on to say that “the patient found, by expanding his geographic search, Dr. Kaushik Mandal at Hopkins. Within 5 minutes Mandal returned the call” (in all of these medical anecdotes, the doctors are incredibly responsive and compassionate in addition to promulgating the latest, most expensive techniques in cardiology).

He flew to Baltimore and had the mitral valve surgery and was discharged a week later with “no restrictions.” The reader could not have been in any doubt about the outcome for Mr. Watkins, as this one case was selected from the entire experience of the hospital to highlight a good outcome.

One has to question, however, that the patient was discharged with “no restrictions.” Really? The doctors were fine with activities such as driving a car and lifting heavy boxes one week after a thoracotomy?

A more significant criticism of this promotional puff piece and similar marketing material is the total lack of an objective, balanced approach to the risks and benefits of the procedure compared to standard approaches.

Is there any evidence that robotic assisted mitral valve repair provides superior outcomes to non-robotic assisted minimally invasive repair? No.

Dr. Alfredo Trento, a proponent of the robotic mitral repair system approach writes

A consensus statement of the International Society of Minimally Invasive Cardiac Surgery (ISMICS) 2010 on minimally invasive vs open mitral valve surgery concluded, on the basis of review of retrospective studies, that, in patients with mitral valve disease, minimally invasive surgery either robotically or through a right minithoracotomy may be an alternative to conventional mitral valve surgery, given the similar short and long-term mortality and also the reduced sternum complications, transfusion requirements, and hospital stay. However, the risk of stroke was higher with minimally invasive surgery than with conventional approaches (2.1% vs 1.2%) as was the risk of aortic dissection, phrenic nerve palsy, and groin complications; additionally, cross clamp times and cardiopulmonary bypass time were increased.

Far too often in medicine, hospitals adopt the latest and greatest expensive technology or procedure before it has been proven superior to existing approaches.

One of the major driving forces behind this reckless spending is marketing the hospital and it’s “cutting-edge” approach to disease management.

As patients and physicians, we need to resist this kind of marketing and insist on an honest and balanced approach to evaluating newer technologies and surgical approaches.

Cardiologists and cardiac surgeons working in the centers that produce this kind of misleading marketing material should take responsibility for what is written and insist on an accurate description of the advantages and disadvantages of their techniques.

Healthy Skepticism and Bias in Cardiology : Let’s Eliminate Drug Ads from Scientific Publications

The skeptical cardiologist has been asked by a number of his patients  “Why are you the skeptical cardiologist?”  In essence, I think they are either asking what does “skeptical” mean or what makes you skeptical and why should I care?

In the About section of this blog I wrote “All of these experiences have taught me to cultivate a healthy skepticism for information that has potential bias.”

Whereas skepticism initially was an approach that doubted the veracity of everything and questioned our ability to know anything, healthy skepticism accepts the veracity of information only after it has been evaluated by a scientific or evidence-based approach.

John Byrne, MD, has a wonderful website, skeptical medicine, which describes in detail the skeptical doctors approach.

The modern skeptic is a scientific skeptic. We use proper science and basic ethics to inform our decisions. We withhold acceptance of claims until proper evidence is presented. We use axioms such as ‘Occam’s Razor’, ‘Extraordinary Claims Require Extraordinary Evidence ‘, and ‘Correlation is Not Necessarily Causation’ to evaluate claims. The skeptic recognizes that humans are prone to biases. We recognize that people defend their biases with logical fallacies. Skeptics understand that we are all prone to such biases and fallacies, even skeptics.  To overcome these tendencies, we must learn about biases and fallacies in order to spot and correct them, especially in our own thinking.

Thus, as a skeptical cardiologist, I am doing my best to use scientific approaches to evaluate recommendations for lifestyle, testing and treatment in the world of cardiology. I do not accept recommendations in these areas from cardiology authorities (American Heart Association, American College of Cardiology guidelines, scientific conferences), media, or the government, without carefully examining the scientific studies supporting them. I seek to eliminate biases that can undermine such studies and recommendations.

The Influence of Drug Money on Doctors

Identifying bias in medical recommendations is essential. Just as our politicians are heavily influenced by campaign contributions from special interests, physicians can also be heavily influenced by special interest spending.

I have tried to eliminate any possibility of pharmaceutical company marketing from influencing my medical decisions. I used to believe that I could accept meals and honoraria from drug companies and not be biased by them. However, several years ago, I realized that any time I spent listening to a heavily biased pharmaceutical representative promoting their product was replacing and/or competing in my brain with information about medications and diseases from unbiased sources. In subtle ways, even to the most ethical doctors, this has been shown to effect prescribing practice. If it didn’t, these companies would not be spending billions promoting their drugs directly to doctors.

The American College of Cardiology and Drug Advertisements

The major professional organization for cardiologists is the ACC or American College of Cardiologists. I get lots of emails from the ACC offering educational opportunities and information on the activities of the college. The ACC also mails me, weekly, the Journal of the American College of Cardiology, the major publication for scientific studies on cardiology in the wIMG_3297orld. Once a week or so, they send me “Cardiology World News,” which is a summary of relevant articles and developments in cardiology. All of these sources of information from the ACC are riddled with advertisements for drugs. The newer and more expensive the drug, and (it appears) the less the benefit, the larger the advertisements. Accompanying the latest Cardiology World News this last week was the large multipage pamphlet pictured below, touting the fact that Brilinta is “preferred over clopidogrel” for NSTEMI in the updated AHA/ACC guidelines. The skeptical approach is to question the validity of these guideline recommendations by reviewing the studies that they were based on, as well as the possible conflicts of interest of the authors (how many are paid honoraria or have research funded by Astra-Zeneca, the company promoting Brilinta)?

IMG_3299Within the pages of Cardiology World News were several multipage advertisements for drugs, especially for newer oral anticoagulant drugs, such as Xarelto. Even the prestigious Journal of the ACC is stuffed with these annoying advertisements. The emails I get from the ACC often contain banner ads for similar over-priced and over-marketed brand name drugs; the websites of ACC and Medscape are littered with banner ads for drugs. Since I am the skeptical cardiologist, I’ve reviewed the studies that resulted in these drugs being approved, and then make my own conclusions about how to prescribe them to my patients.  Such ads are not useful in my decision making.

When I read journals, studies, editorials or reviews of cardiology information,  I simply want unbiased information. I don’t want my mind cluttered by biased presentations from drug companies.

Why is my professional organization helping to promote these biases?  Obviously, it is for the money.

To the American College of Cardiology I say: “let’s eliminate drug ads from your publications.” With that simple step, we can help reduce the control that pharmaceutical companies have over physicians and move toward ensuring that all of our drug and device recommendations to patients are in their best interest.