Mixed Messages in NEJM Criticism of Cypher Ad

Nevertheless, there's much ado about a DTC television ad for the Cypher stent from Cordis (a JNJ subsidiary), which aired nationally last fall but can now only be viewed in the Baltimore area, according to the WSJ Health Blog. Today both the NYT and the WSJ report on an NEJM editorial against the ad, which was published online yesterday.

In the NEJM perspective, cardiologists William Boden, MD, and George Diamond, MD, question the propriety of airing a medical-device ad to "millions of people who are ill-equipped to make judgments about the many clinically relevant but subtle and complex therapeutic issues that even specialists continue to debate." Despite acknowledged benefits of DTC advertising to both the public and industry, the authors write that they are troubled by the limits of TV ads generally to disclose risks and find the Cypher ad, in particular, overpromising with respect to depicted functional outcomes.*

The curious aspect of the editorial, however, is Boden's and Diamond's objection to promoting a medical device that "can be selected and implanted only by someone with a very sophisticated medical understanding." They write, "It seems almost unimaginable that a patient would challenge an interventional cardiologist's judgment about the use of a particular stent or that a cardiologist would accede to a patient's request for a particular stent on the basis of the information gleaned from a television ad."

So at this point, I'm not sure what their objection is to the Cypher ad: Is the Cypher ad objectionable because it is misleading and therefore potentially harmful, or is the ad objectionable because it is useless, even absurd?

*Last year, Boden et al published "Optimal medical therapy with or without PCI for stable coronary disease," in which the rates of a number of vascular outcomes were no different between patients who underwent percutaneous coronary intervention and those who received optimal medical therapy alone. For what it's worth, Boden reports consulting fees from CV Therapeutics and PDL BioPharma; lecture fees from CV Therapeutics, sanofi-aventis, BMS, and Abbott; and grant support from Abbott.

Photo of Cypher (sirolimus-eluting coronary stent) from http://www.cypherusa.com/cypher-j2ee/cypherjsp/main_splash/stent.jsp.