From Medical Miracle to Abomination

DrRich | February 1st, 2011 - 10:43 am

The implantable cardioverter defibrillator (ICD), an incredible feat of visionary medical science blended with cutting edge engineering, a device responsible for saving thousands of lives a year, has gone from being a prototypical American success story to a symbol of healthcare excess. Today the ICD is widely castigated by the press, the public, the insurers, the government, and even most doctors as the poster child for expensive and wasteful medical technology. Consequently, the ICD and the doctors who implant them have become fair game for whatever the Central Authority wishes to throw at them. DrRich has explored this fascinating phenomenon in this series of articles;

How ICD Implantation Guidelines Are Being Abused

The DOJ Investigation of ICD Implanters, and What It Means

How the ICD Became an Abomination

3 Responses to “From Medical Miracle to Abomination”

  1. Dr.Rich; Surely even you can admit there is overuse and unnecessary implantation of a number of expensive medical devices? (pacemakers, ICD, stents) While I agree “guidelines are just guidelines”, shining a light on health care excess is critically needed. Rather than just sweep it under the carpet as “bad government interference”, why not admit that abuses do occur and voice that this is one reason (I said “one” not the only reason) healthcare in the U.S. is the most expensive in the world?

    • DrRich says:


      Most of my regular readers will know that I have been very critical of abusing clinical evidence in order to either suppress the use of medical technology, or to exaggerate its merits. Further, I have been particularly tough on cardiologists in this regard, since being one, that’s where I know the clinical evidence the best. If you’ll re-read this very article, you will see that I have not been kind here to the electrophysiologists. I have been particularly unkind in the recent past to the stent-ifiers.

      To say it another way, “surely even you can admit” that the act of writing an article written to lament the destruction of a remarkable lifesaving technology is not the same as approving the overuse and abuse of that technology. If it is being overused (and certainly in many cases it is) there are ways of dealing with that short of anathematizing the technology.


  2. Mike K says:

    I have an interesting personal experience with electrophysiologists. I began to get atrial fib with a rapid rate at age 13. My father had it occasionally and it would incapacitate him for several days. Finally his GP (a drinking buddy) put him on digitoxin and that seemed to end the symptoms. I don’t know if he converted or the rate was controlled. My own episodes were occasional and eventually, I learned to stop them with Valsalva or carotid massage (medical school is good for something). As I got older, the episodes became more frequent, especially with vigorous exercise. I finally gave up handball, for example, and stuck to golf. About 10 or 12 years ago, the episodes became more frequent, even without exercise, and I began digoxin. Around the same time, I had an episode that could have been atypical angina and had a treadmill (I had had several). It showed that at a heart rate of 140, I went into right bundle branch block. It reverted to normal conduction when the rate slowed.

    A year later, I was in RBBB all the time. My cardiologist retired not long after and I saw his successor a year or two later with some dyspnea on exertion. We did an angiogram as I was a bit concerned about left main disease.

    I needn’t have worried as I have no left main. both coronaries and both branches of the left come off a single orifice.

    I should add that my a-fib had been getting worse and worse to the point I could not climb stairs or walk a block. Finally my old cardiologist, before he retired, sent me to the electrophysiologist, who looks like a mad scientist. He gave me all the usual warnings, then found an aberrant bundle, zapped it and I have not had a-fib again.

    That was five years ago. Six months ago, I had an MI from a high grade lesion in the LAD. It was very had to find because of the aberrant anatomy. The younger cardiologist readily acknowledged that he could have missed it two years ago. I doubt I’d have made 74 without the technology. My father died at 66.

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