Reflections on a Defibrillator in Every Household*

Bernard Lown, MD

Our newspaper of record, the Boston Globe, headlines on its front page, “FDA approves sales of home defibrillators”(09-17-04) The article explains the reason given for FDA approval, “that the average person can safely operate the machines. When used appropriately, defibrillators can dramatically improve a patient’s prospects for survival.” Both statements are true. Any life saved is precious and worthy of the effort . I should be elated at this popularization, since some 48 years ago, I had invented the direct current defibrillator (DC). (1) Yet, I am not at all pleased, in fact I feel disquieted.

What accounts for my attitude? In my mind the over-the-counter availability of defibrillators substitutes market forces for public health interventions, It introduces practices without scientific evidence of benefit. It astronomically escalates health care costs. It does not address the complexity of the cardiac arrest problem. It ultimately preempts preventive cardiology by promoting technology as a mythical substitute. Instead of enhancing communitarian values, it further atomizes society into individual consumers left to their own devices.

An effective strategy against the formidable problem of sudden death requires identification of the individual patient at risk. Screening for telltale markers can now be readily carried out. It is senseless to leave such a determination to market forces rather than to the medical profession. Clearly defibrillators will now be purchased by those who are readily hyped by fear of impending sudden death and by those affluent who may not be at risk at all. While this may be a bonanza for the instrument makers, it is no boon for public health.

Time Spent with Patients a Critical Factor in the National Health Crisis*

Bernard Lown, MD 

That we have a dysfunctional health care system is now widely acknowledged. No longer does one hear that Americans receive the best medical care in the world. Moreover, the US crisis in health is noteworthy for a blatant contradiction. Despite our investing a king’s ransom on health care, one-third of the population is inadequately protected against the unpredictability of illness. The number of uninsured people has reached a staggering 47 million, with an additional 30 million covered merely for catastrophic illness. No other industrial nation comes close to the approximately US$7000 spent by each American annually for medical care.  

Mounting health expenditures preoccupy economists and politicians. The escalation is ascribed to an ever-aging population with greater health demands as well as to costly scientific and technological advances. What is largely ignored is the commodification of illness that America’s market-oriented health care system fosters. As is true in business, the underlying intent is maximizing profitability rather than promoting patient well-being. Unnecessary tests and procedures are encouraged. A market-based health system also has significant upfront costs and unavoidable systemic inefficiencies.  

Another consequence of the system contributes to its rising costs and malfunction: Market values are the invisible elephant in the doctor’s office. They quench the human dimension in health care and corrupt the doctor-patient relationship. The first casualty is listening. Since listening to a patient consumes much time and is minimally reimbursed, it is most often done in a cursory, hasty manner, leaving the patient frustrated and the doctor uninformed.