This pattern—a paucity of scientific support and a plethora of industry connections—held across almost all cardiac treatment guidelines, said cardiologist Pierluigi Tricoci of Duke University and his coauthors in an article published in 2009 in the Journal of the American Medical Association. “Experts are as vulnerable to conflicts of interest as researchers are,” they wrote, and added that the current cardiac-research agenda was “strongly influenced by industry’s natural desire to introduce new products.”
That desire would be on full display in the spring of 2011, two years after my father’s death, when I parked in a municipal parking garage on Mission Street near the San Francisco Chronicle, my old newspaper, and walked toward the Moscone Convention Center, where the Heart Rhythm Society was holding its annual conference. It was a sunny, windy day in the South of Market district. The first thing that caught my eye was a fleet of black motorcycles repeatedly circling the block, each one towing a shiny black minitrailer bearing the logo of St. Jude Medical (“More Control! Less Risk!”). Towering above me on the side of a two-story building were five orange, turquoise, blue, and purple billboards, each bigger than a movie marquee, trumpeting the behemoth Medtronic’s implantable cardiac defibrillators (“Fewer Shocks! MRI Access!”), its surgical tools for a heart procedure called cardiac ablation (“Inflation/Ablation!”), and its corporate logo (“Innovating for Life!”). A commercial white stretch limousine idled by the curbside, trolling for customers.
Outside the convention center, the sides of official shuttle buses were covered with company logos. Inside the hall were more logos—for Biosense, Johnson & Johnson, Siemens, Zoll, and Greatbatch—plastered on water coolers, on piles of complimentary tourist maps of San Francisco, on Internet access booths, and above laptop charging stations. A sign above the couches of the Infinity Circle where tired cardiologists checked their e-mail read, “Year Round Support: Infinite Gratitude: Heart Rhythm Society,” followed by a list of its top corporate contributors, including Medtronic, Boston Scientific, St. Jude Medical, and Sanofi Aventis (“Because Health Matters”). All told, medical technology companies paid the Heart Rhythm Society $5.1 million—nearly a third of its $16.8 million annual budget—to rent exhibit booths and otherwise promote themselves to the more than three thousand physicians attending the four-day convention. This was the sea in which cardiologists swam.
St. Jude Medical, the maker of my father’s device and the conference’s third-biggest spender, paid $653,000, including $15,000 for ads on the risers of stairs, $45,000 for the privilege of hosting complimentary dinner seminars and other educational events for doctors in hotel banquet rooms, $55,000 to hang banners above stairways, $70,000 to put its logo on the cardiologists’ hotel key cards, and $308,000 for exhibit booth space on the showroom floor. The company was on Fortune’s list of the world’s most admired companies. It employed about thirteen hundred sales representatives and was a member of the Fortune 500, with a market capitalization of $13 billion.
Wearing my press badge and carrying the complimentary tote bag I was handed in the well-stocked press room, I walked into Moscone’s huge underground commercial exhibit hall. It reminded me of a combination of a carnival midway, an auto showroom, and the largest Apple store on earth. Everywhere I looked, flat-screens glowed and pulsed, displaying loops of medical-technology advertising. The average American life span was now seventy-eight and a half, and health care was consuming 17.9 percent of America’s GDP per year. Salesmen and saleswomen with expensive haircuts circled clutches of slim, vital doctors in sharp dark suits. Suspended above our heads in the hangar-like space were gigantic plastic signboards in whites and cool blues and greens, reading, “St. Jude Medical,” “Medtronic,” and “Biotronik: Excellence for Life.”