Turning cynicism into healthy skepticism between clinicians and industry

A former practicing cardiologist, Boston Scientific (NYSE:BSX) executive Dr. Ken Stein has experienced firsthand the cynicism between clinicians and the industry. As an example, Stein cites the issue of battery longevity in cardiac implants as viewed by physicians and those on the medical device side.

Writing for the journal Circulation, Stein – now chief medical officer for rhythm management & health policy at Boston Scientific – noted that doctors believed the industry would never make extended-life batteries for medical devices because they would lose out on profits. But when Stein joined the industry 7 years ago, at Boston Scientific, he discovered that the same cynicism existed in the industry, which suspected that doctors wouldn’t want a battery with a longer life – for the same reason.

Stein told MassDevice.com that the claim is unfounded, on both ends. Boston Scientific introduced an ICD/CRT-D battery 8 years ago with twice the capacity of some competing devices. And when doctors can choose which to give to their patients, the majority pick extended longevity devices, he told us.

“At least the vast majority of devices that go in are the extended longevity devices,” Stein said. “It’s not everyone, but the vast majority of people on both sides want to do the right thing for patients – and they do the right thing.”

The cynicism on both sides is driven by the lack of exposure between clinicians and industry members, he said, noting that when he was in medical school, he hardly interacted with anyone from the medical technology industry and if he did, it was a sales rep on the commercial side. It’s understandable, Stein said, to develop a mutual distrust and cynicism when you don’t have close interactions and personal relationships.

“Of course, the real risk is it’s almost a positive feedback loop,” he said. “The separation breeds lack of trust, and a lack of trust leads to more separation. I think that really feeds it on itself.”

Scientists and doctors are trained to look at situations with a questioning eye. But skepticism can easily evolve to cynicism if one is unable to reconsider a position after being presented with new data, Stein said.

“Skepticism is constructive, whereas I think cynicism’s destructive,” he explained. “Skepticism, I think, is reason, whereas cynicism I think is reflexive.”

The solution to easing the distrust is working together for the benefit of the patient, Stein said.

“There’s not a single important advance that I can think of in my field that hasn’t been the result of collaboration between clinicians, clinical scientists, and engineers in industry. The worry that I have is when cynicism gets in the way of those kinds of engagements, we all lose. Most important is our patients today and our future patients,” he told us.

When Boston Scientific developed the extended longevity battery, they did it in spite of claims that they wouldn’t because of their bottom line. But Stein told us that the financial “survivability” of any medical company depends on the trust of its patients.

“As long as we always continue to put patients’ interests first, in the long run, that’s going to be what’s best for us, too.”

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