Tag Archives: Orlando

Marketing Medicine, Changing Practice, And Groping Watchmen at the American College of Cardiology Meetings

In March, the skeptical cardiologist attended the annual Scientific Sessions of his professional organization, the American College of Cardiology. This year’s meeting was held in Orlando, a city which, for me, holds little allure beyond milder March temperatures than St. Louis.

The meetings are termed Scientific Sessions because lots of science is presented and discussed. The results of the latest, most important and “practice-changing” studies on cardiovascular drugs, devices, and diseases are released to much ballyhoo.

They take place in massive soul and leg muscle-sucking convention centers, where one typically has to hike several thousand meters to get from one presentation to another.

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The Orange County Convention Center-the second largest in the U.S., offering 7,000,000 sq. ft. of space, wifi everywhere, and the opportunity to garner 10,000 steps going from one room to another.

Medical science is best when not adulterated by commercial interest, but the ACC meeting is blanketed by advertisements for the latest (consequentially most expensive) and greatest (hopefully) life-saving drugs and devices.

A feature of these meetings is the draping of the escalators with drug marketing material. Look! Repatha now approved for a new indication!

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I used an app provided by the ACC to find sessions I was interested in, plan my itinerary and to interact with presenters. Quite irritatingly, every time I opened the app, I was presented with a commercial for, you guessed it, Repatha, one of two new (and really expensive) PCSK9 inhibitors.img_1022

I was so irritated by this advertising intrusion into my app use that I totally failed to find out what the new indication for Repatha was. (It was to prevent heart attacks and strokes, something the FDA decided in December, 2017, after reviewing the outcomes data from the FOURIER trial presented at the ACC last year (I listed this as #3 of my top cardiology stories of 2017).

Booth 1807 was in the sprawling “Expo” area of the conference, where drugmakers and device makers compete for the attention of cardiologists by offering espresso-based beverages, free nitrogen ice cream, made to order cannolis (the definite favorite of the Eternal Fiancee’, herself working the Expo for Scimage) and occasional kitsch, like rubber bouncy balls that light up when they hit a hard surface.

Typically, I avoid the cannoli and cappuccino but seek out the oddest opportunity to be seduced by the dark side.

One day I ventured into the Expo area to explore how companies were promoting their products in 2018 and before I knew it I was inside a heart,  grasping a left atrial appendage occluder.

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The skeptical cardiologist standing on the interventricular septum while occluding the left atrial appendage. This is how I ACC!

The Watchman device I was grasping has been approved for preventing stroke in patients with atrial fibrillation who are at high risk and can’t, or won’t, take blood thinners. Boston Scientific has been flying cardiologists to various cities for the last year to wine and dine them and fill them full of reasons to send their patients for the device. Thus far I have avoided going on such a boondoggle. (Read John Mandrola’s skeptical take on Watchman here).

If you didn’t get the message about Repatha from the app or the escalators, there were frequent presentations from investigators at various sites in the Expo floor.

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A lipid expert explaining why cardiologists should be prescribing cholesterol lowering PCSK9 inhibitors. Note the towering graphic “High LDL. Prior CV Event? Time to Act!”

The presenters are typically experts in the field, but are handsomely compensated for their time. Consequently, one cannot rely on this being unbiased information, so I avoid these like the plague. To the ACC’s credit, such presentations do not qualify for CME credit, and are labeled as industry-sponsored.

Despite my irritation with constant marketing and advertisements, and the bias these things introduce into cardiology practice, I get a lot out of attending the ACC sessions.

Full participation allows me to accumulate 34 hours of continuing medical education (CME), hours which I need to maintain certification in the various fields I specialize in, such as echocardiography, nuclear cardiology, vascular imaging, and coronary CT angiography.

I usually find several presentations which advance my knowledge base or change my viewpoint, and how I practice cardiology. This is ultimately good for my patients. I wrote about three of these for Medpage Today here. Consider reading the article, if only to experience the wonder that is the new and large photo of the skeptical cardiologist.

I’ll share some other thoughts from the meetings as time allows. Until then I remain

Skeptically Yours,

-ACP