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Washington Post’s Heart Stopper

A gruesome tale of life-saving heart implant devices: they keep shocking people who are dying from other causes. And this affects how many people?

Implantable cardioverter-defibrillators (ICDs) are small devices implanted into a patient’s body to help their hearts stay regulated. If the heart should experience some irregular behavior or beat too fast, the defibrillator delivers an electric current to “shock” the heart into regularity. Currently over half a million Americans have these devices implanted, and over 100,000 new devices are implanted every year, according to The Washington Post.

ICDs have been credited with saving tens of thousands of lives. In a 2005 study published in the New England Journal of Medicine, those with congestive heart failure reduced their rate of death by 23 percent by using an ICD, compared to those treated with a placebo. The study also found a similarly significant reduction in death rate compared to those treated with heart-regulating drug therapy. That percentage is the relative risk. In absolute terms, among 100 recipients of ICDs, about 7 to 8 will be saved by the device over a 5 year period (and about 30 will die anyway), according to the American Heart Association.

But you won’t get that information from the recent Washington Post article on these devices. According to the Post, ICDs are also causing immeasurable harm. In some cases, the devices continue to shock patients when they are in their last moments. Patients are suffering more pain than they otherwise would be, and family and loved ones are being traumatized by watching their loved ones suffer.

As the heart stops in the potentially peaceful experience of dying, the ICD behaves at it is supposed to – and shocks the patient in a last-ditch effort to keep the heart working. The Post describes two really grisly deaths of ICD-bearers who suffer the consequences as their loved ones sit by, helpless.

The Post article certainly has a story to tell: that of the unintended consequences of medical intervention; it’s a story about how we live – and how we die.

Unfortunately, the paper preferred giving its readers a shock rather than the big picture. The Post’s story makes defibrillators sound like the electric chair; but how many of these devices are actually intervening when a patient is dying, making his or her death more painful? Thousands of people every year, or a handful? And how many are having their lives saved by these devices? Given that the devices can be deactivated by powerful magnets, or even by remote control, is the problem with the devices or with the quality of medical care as we die?

According to the Post:

“The problem is an example of the consequences of medical technologies proliferating before the ethical, psychological and logistic issues they raise have been resolved.”

But is that really the problem, or just part of a solution (to heart failure)? Hard to know, since we have no idea how many people suffer as a consequence, compared to how many people have had their lives saved as a consequence. Should we hold off on using life-saving medical technology in order to sort out the logistics of how to ensure that no one suffers needlessly at the end of life? In part, that may depend on how much suffering, compared to how much benefit.

The Washington Post neglects to give the public the information it needs to understand the ICD issue. While the technique of framing news in the context of a personal story (gruesome as it is) is tried and true, it would be less harmful to public health to see if the anecdote is supported by statistics before going into print.