Skip to Content

Support MinnPost

This content is made possible by the generous sponsorship support of UCare.

Medical-device spokesman's claim on heart disease termed 'overstated,' 'outlandish'

heart pump
REUTERS/Brian Snyder
Medical devices have played a role in reducing heart-disease related fatalities, but lifestyle changes, medications and other factors are also important.

Last Friday, a spokesperson for the medical-device industry published a commentary in the Star Tribune in which he made a claim that simply isn’t supported by the evidence. The commentary was written by Dale Wahlstrom, president and CEO of the industry trade group LifeScience Alley, which is based here in Minnesota.

Dake Wahlstrombiobusinessalliance.orgDale Wahlstrom

The group's members include such local institutions as Medtronic, 3M, St. Jude Medical, Cargill, the Mayo Clinic and the University of Minnesota. (LifeScience's website says its member organizations come from all sectors of "the lifesciences ecosystem.")

In the commentary, Wahlstrom, whose LifeSciences bio says he retired from Medtronic in 2006 after 24 years, argues that Congress should get rid of the 2.3 percent excise tax on medical devices that’s currently in the Affordable Care Act because the tax puts the ability of the medical device industry to innovate and operate “under attack.”

To support that argument, he makes this remarkable statement:

Medical devices save and improve lives. Between 1980 and 2000, medical device technology slashed the death rate from heart disease by a stunning 50 percent and cut the death rate from stroke by 30 percent. As a result, life expectancy was extended by more than three years.

As Gary Schwitzer, publisher of the Minnesota-based Health News Review website, noted on Friday, this is an “outlandish” claim.

“This quote attributes ALL cardiovascular health improvements to devices,” Schwitzer points out, “rather than siphoning off the mere fraction that might be attributable to devices versus drug therapies versus lifestyle changes.”

Many treatments involved

Schwitzer sends readers to a 2007 article in the New England Journal of Medicine that specifically looked at the causes of the decrease in U.S. deaths from heart disease between 1980 and 2000.

The authors of that study say this:

Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors [especially a reduction in cholesterol and blood pressure levels and in smoking] and approximately half to evidence-based medical therapies.

As Schwitzer points out, those “evidence-based medical therapies” include not just medical devices, as Wahlstrom suggests, but all methods of treatments, including drugs and surgery.

Here’s what the study says:

Approximately 159,330 of the deaths from coronary heart disease that were prevented or postponed were attributable to medical therapies (minimum estimate, 58,065; maximum estimate, 347,395). The largest reductions in deaths came from the use of secondary-prevention medications or rehabilitation after acute myocardial infarction [heart attack] or after revascularization [bypass surgery] (a total reduction of approximately 35,800 deaths) and from the use of initial treatments for acute myocardial infarction or unstable angina (approximately 35,145 deaths), followed by treatments for heart failure and hypertension, statin therapy for primary prevention, and treatments for chronic angina. The use of revascularization for chronic angina resulted in a reduction of approximately 15,690 deaths in 2000, as compared with deaths in 1980, or approximately 5% of the total.

Overstating the case

Dr. Thomas Kottkehealthpartners.comDr. Thomas Kottke

To get more clarification, I called one of the authors of that 2007 analysis, Minnesota cardiologist and researcher Dr. Thomas Kottke, and asked him about Wahlstrom’s claim about the impact of medical devices on lowering the heart-disease death rate.

Was there any truth to it?

He laughed. “There has been a big decline in heart disease mortality,” he acknowledged, but it had “hardly anything to do with medical devices.”

The reduction in deaths “was mostly because of risk-factor changes,” he said, as well as “improved care and drugs.”

“He’s overstating the case for devices,” Kottke added.

Misleading politicians?

I called LifeScience Alley twice on Friday afternoon to ask for the source of Wahlstrom’s statement. I was told they would get back to me, but so far I’ve received no answer. (I’ll update this post as soon as I do.)

As Schwitzer notes in his blog, “The editorial is more than a matter of playing loose with the numbers; it is a vast overstatement and a distortion of the evidence. There’s no question that medical devices have contributed to the decline [in heart disease deaths]. It is disingenuous to attribute ALL of the benefit to devices.”

“I only hope that such whopping misleading claims aren’t misleading politicians into position they wouldn’t take if they evaluated the claims,” he adds.

A repeal of the controversial medical device excise tax currently appears to face an uphill battle in Congress, although it has bipartisan support from Minnesota's politicians.

Get MinnPost's top stories in your inbox

Related Tags:

About the Author:

Comments (9)

Two Sides

Aside from the obvious misrepresentation of facts by Walhstrom, there's an issue that he and this trade group seem willfully unwilling to confront: the tax on medical services.

Since every patient who receives medical care in Minnesota pays an added tax of 2% to fund MNCare, this obviously creates a double standard. The argument that Wahlstrom and LifeScience Ally are making (without directly stating it) is that it's okay for people who need medical services to pay an additional tax, but it's somehow an "attack" on an industry that makes devices used in medical care to pay a tax.

We're taxing people who need medical care for treatment of a condition or preventive care, even though the lack of affordable medical care for more than 40 million people is what causes them to avoid seeing a doctor and then need very expensive treatments, which everyone else pays for eventually. This sends a clear message that we don't want people to be healthy so they can avoid needing such treatments, or even ones that require medical devices.

It must be nice to live in a bubble, insulated from the problems of everyone else.

Mr. Wahlstrom's Complaints Ring Hollow

I'd be more concerned if the industry he defends were not a VERY high profit industry with extremely high executive salaries. As they developed, this group of companies benefited from a wide variety of governmental and societal infrastructures which supported them and allowed them to become the fabulously wealthy and profitable companies they are.

It's long past time that they gave something back as just compensation to society for providing what they needed to be born, to grow, and to succeed. Sadly, as companies which should now be acting like mature adults, they are, instead, whining like spoiled children protesting that ALL the toys in the playroom should continue to be theirs and theirs alone.

Like the rest of us have to, and especially their wealthy executives (and the wealthiest people in this country, in general) they need to GROW UP and learn to share. After all, the rest of us learned to do so "in kindergarten."

Hollow complaint, indeed

Any time a corporation makes claims about the “public good” it’s producing, that same public has good reason to be skeptical. Corporations don’t exist to provide public good, they exist to make money, and Mr. Walhstrom is simply engaging in the standard business tactic of labeling anything that might diminish a handsome quarterly earnings report as an “attack.” He’s also using the standard sales technique of attributing to his particular industry ALL the benefits to the public occurring because of some trend. Of course it’s self-serving, and mostly not true, but truth seldom survives an opportunity for corporate spin.

Talking about the color of the beach chairs

The commentary about whether devices or clinicians or patients' personal behavior was most responsible for a national decline in death rate is a lot like talking about whether the beach chairs are purple or periwinkle on Patong Beach in 2004 just before the killer tsunami hit. I am the media relations director for Cook Medical, the world's largest family owned medical device company, and journalists and others need to recognize that this new tax on gross sales is going to cripple our nation's most innovative industry, particularly in Minnesota. It's not scare tactics. It's just the truth.

When applied to earnings, this new and unusual top line tax will equal a additional tax rate of 10 percent to 15 percent. Add to that the five percent to eight percent in state taxes and the U.S. corporate tax rate of 35 percent and U.S. companies are faced with a cumulative tax rate of 50 percent of earnings for products sold in the U.S. Imagine if your company had to pay a tax on sales. Your company couldn't make it.

Now assuming that the same products were manufactured in Ireland and sold in the U.S. and the tax rate break-down goes something like this: 12.5 percent of earnings for Irish tax rate and then the new 2.3 percent tax or 15 percent rate when applied to earnings and you are left with an Irish company having an immense tax advantage when compared to the same product from a U.S. company: 27.5 percent compared to 55 percent.

When observors suggest that it's time for U.S. device companies to "give something back" well, the truth is that companies give back by paying the highest taxes in the world.

Unlike Big Pharma, device companies will not be getting a flood of new patients, either, because reducing the number of uninsured will not increase the number of patients seeking medical devices.

Most of our medical technologies are either used today by patients in emergency situations or by elderly patients who are already insured by Medicare. There will be no windfall for our industry just because more, non-elderly patients have access to insurance. In the emergency room today, patients receive our technologies regardless of whether they have health insurance or not. These devices that are used in this setting include drainage catheters, tracheostomy tubes, intubation devices and myriad of other devices to maintain life. Federal law requires that all patients in need of emergency services be treated regardless of their ability to pay or whether they have health coverage. The ACA does not change this paradigm.

Further, the Administration has stated that the demographic group that will most benefit under the ACA are the non-elderly. Young people tend not to be in need of stenting or other vascular or organ repairs for aging related conditions. Most of the patients that use our products are elderly and today they are either treated in the emergency room without regard to health insurance or covered by Medicare that already reimburses hospitals for medical devices. This analysis is borne out in Massachusetts, which has a similar universal health care approach. Internal analysis shows that medical device sales did not increase beyond the increase expected prior to enactment of the Massachusetts new health law.

We can talk about the color of the beach chairs, as a home-grown industry flees for low-tax nations. Or we can repeal this tax and get back to the business of saving patient lives and reducing suffering.

Truth and accuracy matters

John,

To you, the commentary about what was responsible for the decline in death rate may not require accuracy.

But let me remind you, it was your own industry representative who made the original inaccurate claim. Had he not done so in defense of his opposition to the device tax, this entire thread wouldn't have occurred.

So you can paint it as a discussion about the color of beach chairs.

Others view it as a matter of truth and accuracy. Pretty important stuff to some of us.

Gary Schwitzer
Publisher
http://www.HealthNewsReview.org

Who represents whom

He speaks for an organization - maybe an industry - but certainly not our company.
But to the issue at hand.
I have an idea: let's tax your total revenues at, oh, 5 percent, no, wait, I've changed my mind, make it 2.3 percent and use what we get to fund National Public Radio. How do you think that would work out for everybody at HealthNewsReview.org? Not so swell, I'd guess.

Further

Gary,

Here's how to solve the inaccuracy claim. It would have been better had he written "Between 1980 and 2000, medical device technology, clinicians, physicians and patients slashed the death rate . . ." Even so, I don't see this as an affront to truth as much as it was an episode of jay-walking.

I hope that in the future you will scrutinize the impact of this tax on companies, jobs and innovation, rather than skirting this critical issue entirely by leaving it to others. If so, the chairman of the board at Cook Group would be happy to talk to you truthfully about the harm that is about to befall our nation's most innovative industry.

Regards,
John Eckberg
Medical Relations Director
Cook Group

Mr. Eckberg,The evidence is

Mr. Eckberg,

The evidence is clear that medical devices played only a small part in the decline in heart disease death rates over the past few decades. The research shows that smoking cessation and lifestyle changes as well as just better cardiac care had a far, far greater impact. Your reworking of Mr. Wahlstrom's sentence is also misleading, for it implies (especially by listing devices first) that medical device technology is on an equal footing with those other factors.

Using such a false statement to support an argument (whether or not that argument has merit) is not innocuous. Mr. Wahlstrom's editorial has appeared elsewhere on the Web (in fact, it remains, uncorrected, on the home page of LifeScience Alley), where his inaccurate claim will be read--and spread--as a true statement.

I agree with Gary. That is pretty important stuff to some of us.

Susan

Journalists make cold calls

http://www.no2point3.com/all-signers

Hello Ms. Perry,
There are more than 8,400 people who have signed up at this Web site in the past nine weeks to register their fears that a new, top line medical device tax will slam innovation, cost our nation jobs and harm patient health. I'm pretty sure that not many of them care to quibble over what approach was most responsible for the decline in heart disease death rates. And while I can't speak for them, my guess is they are most worried about hanging onto their jobs next year when this tax goes into effect. You claim to be a journalist but really you write opinion. Maybe you could act like a journalist, pick up the phone and cold call one or two of them for their thoughts. Or maybe you could call one of the Minnesota Congress Members who bucked the party and called on their President to kill this tax and see what they think.
Regards,
John Eckberg
Media Relations Director
Cook Medical