Medical technology—A deadly encounter

Bernard Lown, MD

I first met Ed K. after he died, or so I was certain. Therein began an experience the ending of which was as bizarre as its beginning. 

A dreary winter afternoon was dragging on endlessly. I was interpreting electrocardiograms for the Peter Bent Brigham Hospital where I was a postdoctoral trainee with the renowned cardiologist, Dr. S.A. Levine, in the early 1950s. The three-month rotation was sheer boredom. Suddenly, a breathless, frantic nurse burst in from the men’s public ward across the corridor. She announced that Mr. K had had his “final cardiac arrest.”

“Come quick!” she urged, “I have been unable to locate an intern.”

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.