I was reading the Feb. 19 US News & World Report and came across a section of drug and device advertising after its "Health Watch" section. I guess I am now inured to drug ads because the only ad that really caught my attention was the one from Medtronic for its implantable cardiac defibrillator ("ICD"). It is quite similar to the company's web version of the same material.
I am trying to figure out how well this ad works, and I welcome your thoughts.
Here's my perspective. First, I am a capitalist, and I believe that firms and hospitals and others have a right to advertise, subject to normal societal rules about content and accuracy. So, you won't find me saying that ads of this sort are immoral or unethical -- although I truly understand why some people believe that. Second, I am always curious to understand why an ad has been placed, why it has been designed the way it has, and what the target audience is.
So, I look at this ad for an ICD, and I try to figure out what the point is. Is the ad designed to tell people with heart problems about ICDs? It seems to be written that way -- "If you've had a heart attack, or have heart failure, an ICD could make a big difference" -- but how can that be? Surely, anyone who has severe enough heart disease to warrant an ICD is highly likely to have been told about this option by his or her doctor. Is it worth the money for an ad campaign for the small number of patients who might not have heard about this option?
Is the ad designed to get a patient to ask for a Medtronic ICD from the doctor, as opposed to one from another manufacturer? A minor possibility, I guess, although I am guessing that the MD already has a favored technology that he or she will choose for the patient.
Is it designed to get cardiologists to choose a Medtronic device over another company's? I doubt it, at least in this magazine. Not that cardiologists might not read USN&WR, but I can't see it as their trusted source of information on cardiac devices. Also, this ad is clearly targeted to lay people -- "An ICD can give you more time to do the things you love with the people you love."
Is it designed for the general public, to place a subliminal message in our brain for years hence, when we might develop heart disease, that it is a Medtronic ICD on which we should insist? I doubt it, for I do not believe that ads have that kind of permanence in our memory.
So, I guess I just don't get it, and I am asking for your help. What do you think is the purpose of this kind of ad? And, do you think it is effective in accomplishing that purpose?
(Please, I am really asking these questions because I don't understand. I have no hidden agenda. This is not a critique of this company, this product, or (as mentioned) our economic system! I am hoping that doctors, patients, or manufacturers out there can offer insights to us all.)
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Very often, companies engage in Public Relations advertising. BP is doing it with their "green" ads. Chevron did it with the double walled tanker ads. Exxon has done it. Archer Daniels Midland had a series of ads that were just fluff.
My theory is that when companies engage in this kind of image advertising, there is usually some underlying problem.
OTOH, maybe Dick Cheney has one of their devices and Halliburton paid for the ad!!
Though direct-to-consumer advertising has exploded over the past 5 years or so, I agree with you Paul that it's hard to figure out why this particular device is being pitched directly to consumers. One clue might be in the quote from Vivian -- "if your doctor recommends it, you should do it...". This sounds like it's trying to sell the treatment approach rather than the type of ICD per se. What's the alternative to an ICD for patients who have this condition?
Another angle might be, as Bwana suggests, building good will (both in the lay sense and in the accounting sense). Since Medtronic is publicly traded, they may be building their brand among individual investors.
As an aside, many people (myself included) have seen D-to-C advertising by pharma companies as pernicious and wasteful. However, in this era of patient empowerment where physicians are now laying out the options for patients and asking them to decide, the information aspect of this type of advertising may be increasingly valuable to patients since it's usually presented in easily understandable ways (though obviously biased).
I concur with the comments above. If you look at this as product advertising, it fails for all the issues you raised about targeting and who's the actual buyer/decision maker. This is institutional advertising that they most probably wouldn't do if they weren't a public company. The product is just a pretense here. Other manufacturers such as Siemens will likewise advertise medical devices on airport billboards just so that their brand can bask in the feel-good values of said products.
Medtronic’s year end is April 28, 2007. Stock prices plunged on the news ICD sales were down 2%. Despite the negligible impact on sales, the ad props up the company image. The company is making a final drive to boost stock price by the end of the year because bonuses are based on year end results.
If the ad were for an AED, which consumers could buy for home use in an emergency, it would be much easier to understand. For the ICD, I don't get it either.
To me, this is clear evidence of a company who is on board with the consumer-driven healthcare concept. However, I'm not sure that we are at the point where Joe Consumer has the ultimate say in his drug/device selection. And I'm not sure if or when we will reach that point. Some administrators are still unconvinced that consumers have a choice in where they go for their care and that consumers can and do "shop around".
I think this ad is ahead of it's time and is a waste of time, money, and space. It attempts to place some sort of diagnostic expertise on the consumers of healthcare. I think this company really missed their target audience. They should be marketing to doctors, using statistical support for the effectiveness of their device. It is foolish to believe that merely by having a patient ask their doctor about this device, the doctor will recommend it.
Great post Paul! I enjoyed this discussion!
How likely is this magazine to be in the relevant doctor/clinic waiting room?
There has been some question about these, so this is general "informational" advertising. They can't say, "Endorsed by Dick Cheney," so they go in a more general direction. The more times something is mentioned, the more likely a patient is to think, "Hmm, I have heard of that." Over the years, as a medical writer, have developed a favorable opinion of Medtronic. Maybe from ads like this, but I don't think so. This ad is all part of integrated marketing--the website, the ads, the placed mentions, etc.
Now here's a topic near and dear to my heart (pun intended!.) I actually have a Medtronic ICD, and seen these ads and discussed them with my cardiologist and my cardiac surgeon. When they presented the decision to install my ICD, they told me that although Medtronic was in the news for recalls, this particular ICD had a longer lasting battery and was safer than the recalled versions, and that the advertising for the ICD was to both reassure cardiologists that these new models were safe, and to plant that idea as well into the minds of cardiac patients considering having this surgery.
So far, I haven't had any problems with my ICD and it's been a full year now. But since it was installed, Metronic was acquired by another larger company, and the ads are still running, which I find peculiar. And I've seen them in standard magazines as well. So my guess, based on my own experiences, is that they're trying to alleviate the negativity of the recalls by placing the ads in general publications for the public to digest, just in case.
I haven't seen the magazine ad, but the link includes people with arrhythmia experience; I assume the ad does too. As a person with asthma, who is always on the lookout for something better (i.e., less grim side effects) than drugs--I've tried yoga, acupuncture, allergy shots, megadoses of Vitamin C, even hypnotism(!)--I can only too well believe that people with arrhythmias (or their moms or spouses or children) find that ads about this ailment leap out at them. Over and over we read that doctors aren't always up on the latest innovations. We read that doctors are overworked and don't have enough time with their patients. We all know friends or family members whose problems were missed or misdiagnosed. We read stories about misdiagnosed patients who after years of being told "I don't know" or "It's all in your head" finally find what their mysterious problem is only by googling their symptoms.
At the same time, we are constantly urged to "take responsibility" for our own health by being "informed patients."
I remember all too vividly asking my pulmonologist about a promising new med I'd seen an article in the Wall Street Journal; he had not raised the issue as a possibility; I had to. "Well, you could try it if you like," he obliged. "I have some samples." Allergists have given me flat out wrong advice. "Use natural substances, like wool, and Ivory soap" (I'm remarkably allergic to both.) Different allergist: "If you move, in 18 months your symptoms will be right back up to the level they are right now." Been 23 years now since the move, and they're not. GP: "Looks like you've had a tonsillectomy." Nope. Experiences like this reinforce patients in their belief that far more is up to them than they might like.
We know that ob/gyns do more C sections than necessary because they are (not surprisingly) concerned about liability issues. If doctors are over- or mis-treating patients, then there is still more reason to do our own research.
We are urged to write down our questions and bring them to our next appointment.
Right now there is a big campaign to teach women that far more women die of (often silent) heart problems than of breast cancer.
I think it makes a lot of sense for ads to educate patients with heart histories. If all the ad does is to indicate to you that you have less need of the implant because you have arrhymthmia but without a prior heart attack, that is worth knowing. If you check off a lot of the boxes, then you feel a bit more knowledgable discussing with your doctor the possible introduction of a medical device into your life.
Finally, there is a ripple-in-the-pond effect. I may not have the problem, but I may read the ad out of curiosity, and may happen to speak with someone with the problem. That's useful indirect advertising.
Anne (sorry about the anonymity, but I don't have a blog.)
I think it might just be to popularize the technology.
That or maybe the preexisting business model that says you HAVE TO HAVE print advertising for your product is mindlessly whirring away its gears here.
Worldpeace,
Ben
Do companies get a tax break for advertising expenses?
You can ask the same question of companies like GE or BASF ("we don't make the products you buy, we make the products you buy ... better.")
The easy answer is "presence." You get a name and an identity in the minds of consumers and potential investors. Ads long ago stopped being about issuing commands to consumers as they have been about building images in their heads, oftentime to counter bad ones (see above discussion of negative PR)
That doesn't make any advertisement of overly-specific medical devices or drugs any less confusing, nor does it make anyone worried about off-label uses and overperscription of drugs any less worried.
I commented on this on Health Care Renewal (http://hcrenewal.blogspot.com/) here:
http://hcrenewal.blogspot.com/2007/01/medtronic-marketers-try-to-sell.html/
My first guess is that the ad is a symptom of the dominant position that marketing folks have in big pharma/ biotech/ device companies.
My fear is that the ad may push patients who could conceivably be candidates for the ICD, but for whom the benefits of the device might not outweigh its harms, to push their physicians to implant one.
In particular, for patients who have had a myocardial infarction (heart attack) and who have a poor ejection fraction (pumping ability of the heart), but who also have another severe disease that might decrease life expectancy, and hence would have been excluded from the clinical trials of the devices, whether the benefits of the device outweigh its harms is unknown.
Well, you raised a bunch of questions... and I scanned the comments so hopefully I won't be too redundant.
"Is the ad designed to tell people with heart problems about ICDs?"
Why not? They may not have developed into serious enough conditions (yet) to warrant a doctor's advising them to look at an ICD, look at Medtronic's version of risk factors that should cause me, the 30-something consumer with little to no known problems, to think about my future needs for a magical resurrecting device.
Let's not forget that ads may appear to target patients, but more often they target patients' family members and caregivers.
I have trouble with some of the ads on TV ("...does your leg want to move? Maybe you're sick...") but playing the part of a good capitalist consumer, I'd prefer we have them than not, simply because at least that leads to things like device Web sites that I can explore by myself without taking a doctor's word for gospel.
If we truly want consumer-driven health care and the requisite transparency therewith*, then we have to stomach consumer-targeted advertising for health care services. We asked for it. Kinda.
Hands up how many non-sick, non-industry people in the room have heard of a device that can restart your heart if it stops?
Very few, methinks.
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"Is the ad designed to get a patient to ask for a Medtronic ICD from the doctor, as opposed to... "
Well, why not? One of the answers I have to give to opponents of public report cards time and time again is "we want the patient to start the conversation". Better informed is better cared-for.
Maybe the doc says "no way, Medtronic sucks, we use Product X", but now we have a world where I can say "well wait a minute, I read online that Product X has batteries that explode if stand on my hands". The doc can use his training and professional knowledge to steer me right if necessary, but now I am armed, I am informed, and maybe I can save myself from getting the device the doc has not yet had time to read all the literature on.
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"Is it designed for the general public, to place a subliminal message... that it is a Medtronic ICD on which we should insist?"
I agree mostly that no, probably not. But nonetheless, if Medtronic can stimulate business in ICDs in general, they'll make out better than if they didn't.
Being a way-more-informed-than-I-should-be consumer doesn't help me stay objective, but maybe cynicism goes hand in hand with capitalism, I think no higher of medical device producers than defense contractors.
Everyone's out to make the best product they can, get it to market and profit, hopefully feeling good about yourself on the way there. I don't disparage it, but knowing it helps me make a more informed decision, I believe.
So yes, I think the ad is effective in letting the world at large know about ICDs, reminding people who had a heart attack four years ago about ICDs, reminding middle-aged folk who have SCA in the family about ICDs, and of course reminding the investors that ICDs are good business, they let you get more bedtime stories and hugs with the kids so let's all buy some stock.
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Hospitals do it too: This is a hospital plugging the procedure, not a particular device, but still, it's just advertising.
And don't miss the amazingly well-worded "How to find a doctor if you have Sudden Cardiac Death" on this page.
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* Please excuse the above sentence construction.
Recently, there has been a lot of press about issues with ICDs (Guident.)
Medtronic rolled out this publicity campaign in an attempt to counter this "negative press" in the market.
Wise words being spoken: "... ads may appear to target patients, but more often they target patients' family members and caregivers."
The hang up I have with the technology is the fact that its not preventative ... it's reactionary, symptomcentric and hard core. Furthermore the technology is cool but if you're going to go as far as implanting electronic devices in human beings, making them cyborgs, why not go ALL THE WAY.
All the macro stuff needs to be nanonized.
Worldpeace,
Ben
But most importantly, did the ad say to ASK YOUR DOCTOR IF AN ICD IS RIGHT FOR YOU?
My bet is that somebody in the organization said "we need to advertise" and nobody had the gumption to ask the kinds of questions you are now asking. They "checked the box" and can say they did it when asked.
Given the obesity and attendant problems epidemic, I think the ad provides additional support for the "take a pill" attitude that permeates our mindsets. It says to the already overweight and out-of-shape consumer that if you decide not to push away from the table and get some exercise, it’s really OK b/c we are here to catch you when you fall. It gives me and the already overweight and out-of-shape consumer a warm fuzzy feeling to know that I’ll be taken care of even if I’m too weak to take care of myself. I’m not a health care provider and it is prob a good thing b/c my attitude is “If your are not going to at least try to take care of yourself, there is nothing I can do for you. Next.”
I work in a medical device company and can give you a personal impression. A big challenge with medical devices is the creation of the market.
You can come in with a product that reduces surgery time and saves a hospital lots of money, but if it is not the standard of care, getting market penetration is very difficult.
The traditional marketing would target the doctors, through prof ed campaigns and such. Ads like these on the other hand create awareness of the new technology on the ultimate customer, the patient.
It gets patients to talk to doctors. They will come in and say "Dr., you mentioned you need to operate, but here you see an alternative where it states you do not need to anymore"
Another thing it does is create brand awareness, which I imagine will help later on when the medical device company begins to negotiate with insurance companies for reimbursement.
The risk is that when you launch a market development ad, you might inadvertently provide free advertising for your competition as well. I have seen devices marketed by one company, only to be trumped by the sales force of the competition. The first company created the awareness, and the second company cruised in their wake.
A second risk is that to certain pundits, the image being shown is one of greed and self interest. I imagine that the decision to publish one of these ads is difficult. On the one hand, if you want to sell, people need to know. On the other, there is the current environment we operate under. My opinion is that as long as the ads are truthful, there is no harm done.
Of interest, I recently received my first issue (unsolicited) of the freebie "M.D. News" (my husband and I are both M.D.'s) In it was an article entitled "Early recognition of risks for sudden cardiac arrest." Guess who was the only M.D. quoted in the article? David M. Steinhaus, M.D. Vice President and Medical Director of Medtronic! Among his quotes, "It becomes critical for people to recognize that they are at risk. At Medtronic, we are trying to promote public awareness of SCA (sudden cardiac arrest), so that those at risk will go in and talk to their physicians about it. It is also the responsibility of physicians to screen for people who are at risk."
This is called creating your market.
Most likely, the ad is a by-product of the end-of-year race to empty out the marketing budget. If Mar-Com doesn't spend to its budget, it runs the risk of cuts in the next fiscal year.
you all have it wrong...many details at camh board at raging bull where you can read my blogs on the icd subject..
Bottom line..for years there has existed a test to better stratisfy patients at risk, but icd companies, got in their way because they felt it would reduce icd sales....So now since medicare has approved the mtwa test, icd companies are now beginning a campaign to broaden the potential population pool to compensate for the loss of unnecessary icds , by using the mtwa test.....read my blogs...dflawed
Dflawed has it correct. Spine.
http://www.med.umich.edu/opm/newspage/2007/icd.htm
I am a cardiologist and I witness this sort of sordid and shameless excess every day.
The problem is that my colleagues welcome this sort of direct-to-consumer advertising. "Doctor, the ad said I might need a defibrillator. Is that true?"
It amplifies the deficiencies of the current withering doctor/patient relationship by abbreviating the doctor's need to justify a procedure, since a slick ad did it for him.
Like DTC drug advertising, it serves one ultimate goal: growing revenues for Medtronic. I had dealt with this company for years until I stopped talking to their represenatatives about 5 years ago when I finally gave up in trying to argue with their brainwashed single-mindedness in promoting their products, whether or not a patient needed them.
However, I am impressed that a hospital administrator voices such an against-the-grain, non-revenue seeking opinion. Unfortunately, I believe that you are in the minority. The hospital administrators I know are hungry for any procedure that brings more hospital revenues, especially heart related.
I know you all will think I am way "Out There" but I think these ads are to push icds as preventative devices for those with minor heart issues or with family heart failure histories.
My husband is on his second Medtronic's device in 8 years and the peace of mind if gives a person is amazing. Sometimes, for a brief moment, I wish I had one too, just to be on the safe side. I have heard of women choosing mastectomy to prevent breast cancer, and I can imagine a time when you will get your icd at age 50 (for those that can afford it) regardless of your condition. It will be like having a built-in paramedic for seniors and maybe the "I've fallen and I can't get up" company will monitor it wirelessly through the Internet?
In times where young women get breast implants as birthday presents from their parents and old people go under the knife for cosmetic purposes why wouldn't the next step be death preventative device style implants?
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