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Dr. Jarvik isn't the best prescription for Lipitor ads

As a physician with satirical leanings, I enjoy viewing pharmaceutical ads on TV. I find it fun to watch the magicians of Madison Avenue inflate, twist, stretch, connect and contort facts and innuendos, then guess what kind of balloon sculpture will appear.

A few ads are spot-on. Some are just silly. Many seem to say, "Ask your doctor if you're as stupid as we think you are."

The ads for Lipitor, Pfizer's multibillion-dollar cholesterol lowering medication, have always struck me as more perplexing than entertaining. The facts seem straight, and the graphics are interesting and even educational. But I've never understood the choice for the spokesman — Dr. Robert Jarvik, a pioneer in artificial heart technology.

According to an article in the New York Times, a congressional committee thinks that's because Jarvik's credentials, or lack thereof, might make the Lipitor ads misleading. After all, Jarvik's medical education stopped after medical school, which means he's an "M.D." in name only. He doesn't see patients, doesn't have a medical license, can't prescribe Lipitor (or any other medication) and certainly isn't a cardiologist. Jarvik himself seems confused about his professional identity; in a statement on his website, he refers to himself as a medical doctor, and later, as a medical scientist.


Prevention vs. late intervention
The Times also points out that if Jarvik's medical credentials are perhaps a bit inflated, his sculling skills are entirely concocted. A stunt double was hired to depict Jarvik rowing across a glistening lake (glistening, like the inside of a clean artery).

But it wasn't the faux sculling that bothered me, or the fact that Jared, the Subway sandwich guy, is possibly a more relevant spokesman for the product he represents, having lost 240 pounds on a Subway diet.

It comes down to a point he makes poignantly in some of the Lipitor ads: The young Jarvik dedicated himself to "the battle against heart disease" because it killed his father. That's a lovely sentiment, but I'd say his ambitions were misplaced. Jarvik put himself at the wrong end of the fight. When patients get to the point they need one of Jarvik's artificial hearts, the battle has been officially lost.

As a colleague of mine says about his coronary bypass surgery trade, "I practice palliative cardiology," and as Jarvik himself has emphasized, lowering cholesterol is all about preventive cardiology. Yet Jarvik dedicated his life to battling house fires not by handing out smoke alarms or fire extinguishers, but by showing up when the house has been reduced to ashes and offering a temporary shelter.

If Jarvik is conflicted about whether he is a doctor, he's also confused about his celebrity status. His statement on his website reads, "I am not a celebrity," and yet when Diane Sawyer asked him how much he has been paid by Pfizer, he replied, "I'm paid an amount that, I think, for a celebrity ad, would be considered a lot for most people."

Name recognition goes just so far
Maybe that's why having Jarvik pitch Lipitor seems to me like asking Jane Goodall to promote bananas, seeing as how she has worked with chimpanzees. The association is thin and based on celebrity. Jarvik appears to be the Right Guy for Pfizer because no one else has the same name recognition.

"The Jarvik Heart" means something to aging flower children with cholesterol problems, even if they don't know what that something is — even if it's only their subconscious that can remember the day in 1982 when retired dentist Barney Clark had his failing heart replaced by the "Jarvik-7." Clark died 112 days after the operation, but the "Jarvik heart" name recognition lives on. Even the Times' headline refers to Jarvik generously and vaguely as a "heart pioneer."

To this point, artificial heart devices have been more medical curiosity than practical medical therapy. It's ironic that the halls of modern cardiology are filled with physicians whose monumental accomplishments haven't created the media spectacle of the Jarvik-7, but whose contributions to cardiology have been far greater in scope.

The numbers tell the tale. The U.S. Centers for Disease Control reports that 700,000 Americans die of heart disease each year. Since Barney Clark in 1982, the Jarvik-7 artificial heart has been implanted in 350 patients (if one includes later models under the names Symbion and Cardiowest). Jarvik's new model, the Jarvik 2000, is a heart-assist device rather than an actual heart replacement. So far, it has been implanted in 200 patients, generally as a temporary device until they can receive a heart transplant.

None of this diminishes Jarvik's clinical sophistication, or the immensity of his engineering and physiology skills. But if you run off and join the media circus, you could end up looking like a clown. Pfizer should find itself a new spokesperson, preferably someone who has dedicated his or her life to preventive cardiology and who can perform his or her own stunts.

Or maybe they should drop the doctor-sculler-sage thing and go with the sentiment Jarvik uses to conclude his website statement. It seems a far more honest representation of his clinical expertise: "I am a medical scientist specializing in advanced technology to treat heart failure who understands that no one in his or her right mind would want an artificial heart if it could be avoided with preventive medicine."

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Comments (2)

The more important issue about this type of advertising is: Why doesn't the medical profession speak up loud and clear about the ethics of advertising proprietary drugs? What doctor is interested in having his patients tell him what drug the patient thinks is good for the patient's particular malady? If the drug companies didn't spend the billions (yes, BILLIONS!!!), of dollars they spend on marketing their drugs to the general public, they would have that much more available for the R & D they complain they say they spend, thereby justifying the outrageous cost of their drugs. Lipitor is one of the worst in terms of cost to the patient.

Your points are well taken Mr. Brill.
It's a complicated subject, for sure,but the question is, who do the pharmaceutical companies serve? Patients or shareholders? Marketing tends to be oriented to shareholders (are there thousands of impotent men out there who don't know there's a pill for their problem; or are the companies just trolling for more business?). And R+D tends to be more patient focused (what medical ailment is in need of a cure?). I have an MD, not an MBA, but my business friends tell me that marketing/lobbying is a far better return on the dollar than R+D, whether one is selling pills or toilet paper.
I'm not sure why physicians don't speak up about these direct-to-consumer ads. I suspect it's because they're either too busy, or feel outgunned.