Should Pfizer Dump Dr. Jarvik? Tell Us
50 CommentsBy Ed Silverman // February 8th, 2008 // 4:40 pm
Dr. Robert Jarvik can’t prescribe a drug, not even Lipitor. He’s not licensed, remember? And now we learn that, even though he looks good in those ads rowing across a beautiful lake, it wasn’t really him in that boat. The ad agency used a stand-in, or sit-in, to be precise.
The revelations are generating interest in Congress, which is investigating pharma’s use of celebrity spokespeople. And the stories about Jarvik are making front-page news - after all, Lipitor is still the world’s best-selling prescription med and those Jarvik ads are ubiquitous.
Pfizer is worried about squeezing as much as it can out of Lipitor, of course, because its pipeline is nearly dry and the cholesterol med loses patent protection in a couple of years. So it’s not surprising that splashy ad campaigns are front and center. But he’s reportedly getting paid $1.35 million, enough to take rowing lessons. Pfizer, however, could invest that in research.
At this point, you have to wonder whether Jarvik is hurting the brand. What do you think?
Should Pfizer Get Rid of Dr. Jarvik?
- Yes (69%, 218 Votes)
- No (31%, 98 Votes)
Total Voters: 316
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ol cranky
First off, let me come clean and say that I think that DTC advertising of prescription medications is horrible and should not be permitted. Prescription products are not the same as other consumer products as a licensed HCP must make a clinical evaluation & decision to administer treatment followed up by giving a patient a note that legally authorizes the patient to obtain the product from another licensed professional. While some doctors (too many) will write a prescription because a patient asks for it, the decision regarding what is and is not appropriate medical intervention is made by the HCP. Contrary to popular belief, the banning of DTC ads for prescription meds is not a violation of the right to free speech as manufacturers can and do advertise to HCPs (the people who, essentially, control sales).
Back to the question at hand. The use of Jarvik as a spokesman and reference to him as Dr. Robert Jarvik in the context of the commercial is misleading. While he did earn an MD, he did not complete the minimum medical training to act as a licensed HCP (he completed med school and that was it). I was in the waiting room of a cardiac center recently when the Jarvik ad came on and I made a comment that Jarvik was never a practicing/licensed physician to the person I was with. Every person in the waiting room asked if I was serious, they were all under the impression that he was a practicing cardiologist, that the reference to the Jarvik heart was so people not familiar with him would recognize his credentials, and that he was speaking and advocating as a cardiologist.
I went to a party in which most of the attendees were in the industry, many of whom have worked in the development or marketing of CV drugs. When I brought up the ad to them, many thought the ad was misleading and implied he was a cardiologist. Of course many of those people (myself included) had originally thought he had a doctorate in biomedical engineering which lead him to develop the Jarvik Heart.
To sum things up: industry insiders think this is a sham, the general population thinks Jarvik is a world-renowned cardiologist. At least in the old days, it was OT products, and the pitchman made it clear that while he played a doctor in TV, he wasn’t a real doctor.
Chris
I don’t think he’s hurting the brand because of this latest news which probably won’t disturb too many people. I bet all those couples in the Cialis ads don’t really take baths in the middle of the woods, and the people in Procrit ads aren’t really on chemo. But if he hadn’t invented the artificial heart, that would be misleading.
ps Pfizer spends $1.35 million on research every couple of hours year round(rough calculation).
Laurie
” I bet all those couples in the Cialis ads don’t really take baths in the middle of the woods, and the people in Procrit ads aren’t really on chemo”
The difference is that those “regular people” aren’t percieved as doctors. They are people taking a drug and are portrayed as such. Jarvik using the “doctor” title, while not illegal is misleading.
Diane
I really believe Pfizer should drop Lipitor or at least stop exaggerating the benefits and downplaying the side effects. I have been off Lipitor, on the advice of my PCP, for 5 weeks. He thought it was causing the tremor I had developed in my right hand and had me so incapacitated I was considering implants in my thalmus to stop them. After two weeks without Lipitor, my hand began improving and after 5 weeks, I can again write my name, make out and sign checks, use the computer mouse and keyboard and eat or drink without spilling food and liquid all over the table. My cardiologist says, “Lipitor couldn’t cause that tremor.” I say I’ll never take a statin again.
Arlene Teck
If the people shown in ads really did do all those things the ads portray, many of them would be dead by now. Like novelists — if they really DID everything they wrote about in their novels, they’d ALL be dead by now. Same with actors in movies. The take-away is: Don’t try this at home. As for Dr. Jarvik, let’s give an old guy a break; he has to make a living like the rest of us. And I don’t think this current flap will cause anyone to back of Lipitor. No, Jarvik is not hurting the brand. Only an adverse experience with the product itself could do that/
Bob Freeman
From talking with a few ad research people, the Lipitor ad has mixed viewer responses: they tend to focus on Jarvik more than on Lipitor. At this point, Pfizer’s probably not gaining an incremental sales dollar from any Lipitor ad. It’s a saturated market so all they’re really accomplishing is brand recall, and in this specific ad, perhaps not that effectively. (When the first drug in a class has DTC support, the ads generally result in a $4 increase for every $1 spent; after the market is competitive, DTC spending tends to benefit the class rather than the individual product.)
Matt
Does it matter if he pitches the drug or Britney Spears or Sally Fields? Anyone who buys a product based on a commercial is an idiot so let them see what they want and leave the issue alone…
Lisa Van S
Matt,
Britney Spears is a perfect example that antidepressants and antipsychotics lack efficacy.
ol cranky
Hmmm, Britney pitching meds big Pharma’s babies. . .
I have a campaign in mind but I would have to spend the rest of my life reciting hail mary’s and our fathers to avoid the express train to hell
Chris
<>
OK but I thought the misleading issue was the rowing. It was never suggested that he was a cardiologist. He is a medical doctor. (He could be a Ph.D in musical composition and still legitimately be referred to as Dr). And by the way, they aren’t taking a drug: they are actors. And he isn’t a rower. And finally, for what it’s worth, which by now is a subway token, I detest those ads. The fact that he designed an artificial heart has no relevance to Lipitor, unless he is seen as the agent of last resort, Hey, whatever floats your boat.
www.worldpharmanews.net
Pharmalot » Should Pfizer Dump Dr. Jarvik? Tell Us…
Dr. Robert Jarvik can’t prescribe a drug, not even Lipitor. He’s not licensed, remember? And today we learn that, even though he looks good in those ads rowing across a beautiful lake, it wasn’t really him in that boat. The ad agency used a stand-in…
Jarvik Schmarvik
Talk about picking nits. This has all the importance of a CNN “Quick Vote”: Should Britney keep custody of her children? Yes or No. I vote for sticking with stories about real science, regulatory and legal issues. Would love to see some coverage of the new Avandia mortality results in NEJM. They have been largely ignored by the media because they fail to portray the drug as a lethal toxin peddled by corporate allies of Satan.
Ed Silverman
Hi Schmarvik,
We ran the poll for a simple reason - the episode raises questions about truth in advertising. And given the current climate concerning DTC ads, I felt this was an interesting example to discuss.
Concerning Avandia, we did post two days ago about the results of the NIH trial that found the drug wasn’t linked to heart problems. You can find that here..
http://www.pharmalot.com/2008/02/avandia-not-linked-to-heart-deaths-in-nih-trial/
I do try to pay attention to such things.
As to other stories, we have three items today about patents, for instance, including one about challenging a state’s sovereign immunity and whether the US Supreme Court will review the debate.
So again, I’m trying to keep things interesting, but also want to provide a little something for everyone, when possible.
Hope this helps,
ed at Pharmalot
Prescription Access Litigation
Dump him? No! In fact, big pharma should expand the ranks of “doctors” to include more actors, fictional characters and cartoons. We had a post on this yesterday at http://www.prescriptionaccess.org/blog/?p=182 in which we propose that pharma use, among others, Dr. J, Dr. Teeth from the Muppets, Dr. Nick from the Simpsons, etc.
Credibility schmedibility!
ol cranky
If you’re going to use a doctor from the Simpsons, shouldn’t it be Dr. Rivera? After all, he did offer a CABG for $129.95.
shade
Actor Noah Wyle of ER fame did a Got Milk? ad in 2000 that introduced him as “Noah Wyle, doctor.” I think the only person who was ticked off by that misleading statement was one of my friends, and she was not happy.
I think the Jarvik ads are misleading, not as much as the above example, but pharma has been pushing the envelope on DTC for a while now. Didn’t Bob Dole have to admit to a prostate problem in his Viagra ads? The tone of those ads has certainly changed. Perhaps a crack down is necessary.
And for Ol’ Cranky - Dr. Nick Riviera is the man!
Jack2
Hi Everybody!
Dr. Hibbert: Mr. Simpson, although we cannot actually fix your heart, we can tell you exactly how damaged it is.
Homer Simpson: What an age to be alive… (said in awed tones)
Matt
Lisa Van S,
I agree.
Chloe
When I first saw this ad, all i could focus on was what a sell-out Dr Jarvik was. I thought, here was someone that actually contributed to science - why does he need to shill drugs for the industry? Did he have to declare bankruptcy recently? Now, to discover, he can’t even prescribe, I can’t figure out who is lower.
ol cranky
Matt & Lisa:
All jokes aside, I Don’t think Britney Spears is a legitimate or appropriate example from which to draw any conclusions about the legitimacy or efficacy of psychiatry or pharmacologic treatment of mental illness. What she is an fine example of is the significant problems in American society’s willingness to place celebrity and fortune above all else; the newfound inability to distinguish fame from infamy; and the barriers to obtaining/maintaining treatment for mental illness.
The Spears situation is replete with a young, emotionally stunted, adult with a personality disorder exacerbated her celebrity and extreme wealth. As an adult (chronologically) nobody can impose treatment on her until and unless she is an imminent threat to herself or others (apparently, the sport of extreme reckless driving on public roads does not equal an imminent threat or any sort of punishable offense/moving violation in LA until you actually have an accident in which someone is injured). One can not expect successful treatment of any kind without her cooperation, compliance and intrinsic motivation to get well. Mental Illness is not a simple bacterial infection for which treating the underlying etiology can cure the infection and resulting symptoms (heck, even eradicating bacterial infection does not always, by default, cure related conditions brought on by the infection). As such, one can not legitimately expect a patient to be well within days of starting a drug regimen from what was, most certainly, too short an in-patient stay. The narcissism and manipulation displayed by Spears interfere with treatment because it affords her the ability to gain support from those who enable (and, possibly, encourage) her erratic behavior & treatment non-compliance thus undermining any attempt at treatment. As previously noted, her situation is exponentially worsened by her celebrity and means. Even with frozen assets, her celebrity provides her with the ability to continue excessive behavior and activities; anyone who helps satisfy her whims is a “friend” (and those friends enjoy the benefit of her celebrity).
There are other celebrities that have struggled with bipolar d/o and/or other mental health issues in public: Patty Duke, Margot Kidder, Kristi McNichol, Delta Burke, Peter Gabriel (allegedly) who may be more accurate examples of the difficulty in achieving stability. There are, sadly, as many examples of the horrific results of untreated psychiatric disorders as there are examples of treatment gone awry (the SAEs).
I, a person with a significant h/o suicidality, have benefited from use of SSRIs/SNRIs in the past. I know others who have also received clinical benefit with limited, if any, side effects from anti-depressants or atypical neuroleptics. The keys to these successes are: judicious use of these medications; insight/awareness of the impact of use of other medications (OTC, supplements & Prescription); additional therapy and patient awareness of symptoms & comprehension of the fact that these are problems for which the patient is the most critical factor to achieving success.
Lisa Van S
Ol Cranky,
Delta Burke has recently signed herself into a Psychiatric Facility. Margot Kidder has chosen a more hollistic approach to her Mental illnes after suffering from side effects. Have you seen the Abilify and Seroquel DTC Ads? These woman are strolling in the park, sitting in a field of flowers, calm, cool, and collected. Britney paints before the whole world a different picture. No one has considered that Britney is suffering Manic episodes due to her ingestion of Prozac/Paxil. And lets not forget that Seroquel has the same side effect profile as antidepressants and carries a Black Box Warning..
This is a very eye opening article:
Healing a Troubled Mind takes more than a Pill
http://www.washingtonpost.com/wp-dyn/content/article/2008/02/08/AR2008020803272.html
LILI
Statin Drugs have made money for Pharmaceuticals, doctors like /dr. Jarvik and the food companies selling fat free foods that are filled with chemicals. Where is FDA and Congress? Medication has become a business not a cure, in fact medications kill people more than we can imagine. Doctors do not report the side effects. The incidence of drug-induced rhabadomyolysis is uncertain, largely because it is not reported. Simiarly the mortality rates are unknown. Statin drugs a major cause of rhabdomyolysis but doctors are not reporting it or treating their patients with this serious side effect from statin medications. I just heard Dr. Jarvik on the TV on Lipitor, he suggests you tell your doctor if you have the following side effects, yet, if you do, the doctors say no, it could be, but it is not. And if you do have all the side effects associated with statin medications, and hospitlized with the serious side effects as mentioned, not one doctor will say it is from statin medications. Doctors will not admit another doctors error, or they are protecting the pharmaceuticals
B. Martin, MD
Pfizer should capitalize on the ad controversy by expanding its Lipitor ad campaign. I want to see Jarvik body doubles doing all sorts of athletic stuff: Jarvik triple jumping, Jarvik ice skating, Jarvik on the pommel horse, Jarvik at the Beijing Olympics…
ol cranky
Delta Burke has recently signed herself into a Psychiatric Facility. Margot Kidder has chosen a more hollistic approach to her Mental illnes after suffering from side effects. Have you seen the Abilify and Seroquel DTC Ads?
Lisa:
I know about Delta Burke’s current situation and I know that Margot Kidder has had a very rough rode with treatment, that’s precisely the reason I gave them as examples (I wasn’t about to only give examples of people who didn’t have some public battles and then be accused of only referencing those who didn’t have significant setbacks and adjustment to treatment).
Britney’s mental health issues started well before she was ever introduced to neuroleptics (there are stories of aberrant behavior and recreational drug use going back to 2002). I brought up her situation in reply to your suggestion that she was an example of a complete lack of efficacy of antidepressants and antipsychotics.
I think you know me well enough to know that I think DTC ads should be banned.
ol cranky
“I just heard Dr. Jarvik on the TV on Lipitor, he suggests you tell your doctor if you have the following side effects, yet, if you do, the doctors say no, it could be, but it is not. And if you do have all the side effects associated with statin medications, and hospitlized with the serious side effects as mentioned, not one doctor will say it is from statin medications. Doctors will not admit another doctors error, or they are protecting the pharmaceuticals”
I know quite a few cardiologists, FP/GPs and they all take rhabdo seriously and remove statins at the first sign of any AE that could be related to the meds (especially if they any c/o of muscle pain). While doctors are notoriously reticent to indicate a colleague has been negligent or committed malpractice, it’s irresponsible to imply that physicians will intentionally disregard a statin’s causation of rhabdo to somehow, protect another doctor. In making that statement you’re implying that use of a statin is, in itself, medical malpractice. It only becomes negligent to maintain a patient on a statin (including switching to another statin) if there are signs/symptoms of rhabdo.
Judith Alta K
Another consideration is the fact that doctors who do not toe the “party line” can lose their license, and more.
Lisa Van S
Ol Cranky,
Britney’s problems go back to 2002.
Exactly;Right after she had been prescribed Prozac. She was also under the age of 25 and more susceptable to psychiatric side effects to Prozac.
Bob
So, Lisa is blaming BS’ problems on Prozac?
Riiiiiiiiiiiiiight…And I have a bridge to see you too…
Lisa Van S
Bob,
Are you denying that Prescription Drug abuse can wreak havoc on one’s life?
Are you denying that Prescription Drugs can cause significant Psychiatric problems?
Bob
Lisa-You made an ignorant statement. Now prove Britney’s problems are a cause of taking Prozac. You can’t.
It’s more of: her mom is a waste, she’s an alcoholic, and no one in her life has ever told her no. On top of that, who knows what combinations of legal and illegal substances she was on.
To sit here and blame it on Prozac is ridiculous. Of course, with your wonder HS degree, I’m sure you could sit here and tell the rest of us why I’m wrong.
truthman
Bob..
Your problem is you don’t want to face the fact that Pharmaceutical drugs can ruin peoples lives just as much as street drugs can..
When will pharma take responsability for anything ?
That will be the day eh Bob? ..
Bob
Truth-Show me the proof it was Prozac. You can’t.
Britney has lived an interesting (I’m saying it nicely) life so far.
To blame it on Prozac either shows a). someone has an ax to grind, or b). the person is an idiot.
someone
DTC should be absolutely outlawed when it comes to cardiology, Cancer and other types of diseases where patients need to rely on the skills of their doctors to accurately diagnose and treat.
Can you imagine how much money we would all save?
Is anyone as tired as I am of seeing how pharma interferes with doctor patient informed decision making. Bad enough that people get sick and have to seek medical attention, bad enough they have to go through the hurdles they go through to get access to health care and appropriate follow up, then pharma lays more mines in their path with fraudulently inflated drug prices and multiple layers of drug access with everyone in the chain ripping them off every step of the way.
Lets all remember; the more you have to spend on selling a drug, the more we should scrutinize the data….
Glad there is a Jarvik heart, he should stick to pitching for his own product…
Atlex
Someone, did you ever hear of the 1st amendment to the Constitution? Does it only apply to you or do pharma companies also get the benefit of free speech?
pharma pr hack
DTC was never outlawed before.. during the Clinton administration, the FDA relaxed the rule which required the full label on all advertising.. so the indications/side effects you see in print (i.e. the big monolith of print on the backpage of the glossy ad) were previously necessary on TV/radio as well making a 30 second spot impossible… it may be time to revisit that decision which has nothing to do with free speech but everything to do with ensuring that communications with patients are both accurate and complete…
Nancy
congress should forget this little concren and worry about men and women dying in Iraq and Afghanistan, our tanked ecomomy the price of fuel and the unemployeed, of which I am unhappiy one. Stop wasting time and energy about stupid things like this and Belichick’s coaching. Get serious!!
Chris
Well I work in big phrma so my views are biased. Personally, I don’t think there are big issues here from a regulatory or moral standpoint. Ok, he cannot prescribe. Who cares. However, you look at it he is a major scientist in the cardiovascular area. And he cannot row. Ok, but like some of the other posters here, it’s unlikely that many of the folks in ads can do what the ads suggest they can and do do. However, I do think there are some real negatives here. The negative is that this situation shows the full extent to which phrma marketing has turned to comodity-like branding and advertising and away from scientific integrity. If you have Dr. Jarvik, a major player in cardiovascular science, why in the world would yo need to take it further and put him in a boat. He is a scientist and that’s what gave the ads credibility. But you can almost picture the scene, 4 Pfizer marketing people and about 8 people from some ad agency in NY, and the ad folks are presenting their market research and focus group data showing that people don’t identify with Jarvik, we need to make him for down to earth, blah blah blah. But that’s what guides us in phrma now. It’s not the science, it’s the consumer focus groups. And that is the story here. And it’s a very sad story because I have watched the change from inside.
I have seen important medical programs and studies cancelled because the Return on Inestment (ROI) would be better from more DTC ad spend. I have been in meetings where NY ad agancy folks are running the show.
The Jarvik ads simply illustrate what has happened across the industry. Phrma marketing teams look for talent now in consumer brands where there is a lot of advertisement. These folks don’t understand the regulated environment, and they don’t care about it. They understand branding and consumer motivation.
Unfortunately, the industry is going to learn a terrible lesson, because science is and has to be the foundation. Consumer might be drawn to the ads like crazy, but health insurance payers are not going to pay top dollar for bells and whistles.
The first Jarvik ad was compelling. But the bubble-gum-selling potato-ship-marketing ad folks couldn’t rest on that alone. Their consumer testing showed that the ads could be even more. But in doing it, they took all the scientific credibility away because in the end, Jarvik was just an actor playing a part, not a scientist anymore.
truthman
Bob
Truth-Show me the proof it was Prozac. You can’t.
Britney has lived an interesting (I’m saying it nicely) life so far.
To blame it on Prozac either shows a). someone has an ax to grind, or b). the person is an idiot.
Show me the proof that psychiatric drugs and psychiatry are not messing up her life….
You can’t either ..
truthman
Atlex
Someone, did you ever hear of the 1st amendment to the Constitution? Does it only apply to you or do pharma companies also get the benefit of free speech?
There’s a difference between free speech and corporate propaganda Atlex..
someone
Altex:
The text of the amendment is:
“ Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.”
So according to you advertising drugs direct to consumers is exercising freedom of speech? O.k. so let’s have the tobacco companies back in prime time advertising on TV. I bet Al Queda would like to recruit people during the evening news…
Sorry, but advertising to patients who do not diagnose, and treat their own disease is not educational, and certainly is not freedom of speech. At best is does a very poor job of providing inaccurate information which foolishly sets the stage for patients to think they should can and must quarterback their Dr into prescribing the most popular drug on the market because the ad says it is.
There is no way to spin this - it will never be right.
Atlex
Someone, I guess you are saying that speech you like is protected, but speech you don’t like is not.
Chris
Atlex -
From this and other posts, you seem to support any communication by pharmaceutical firms (misleading or not, off-label or not) as being covered under freedom of speech. Am I correct in this interpretation?
ol cranky
Atlex:
you’re totally missing the fact that Prescription products are not the same as other consumer products:
* A Health Care Provider (HCP) licensed to prescribe medications must make a clinical evaluation & decision to administer treatment; then
* The “consumer” [patient] is provided with a prescription that legally authorizes the patient to obtain the product from another licensed professional. [alternately, the HCP can treat directly the consumer with the product and/or provide samples]
The pharma companies would not be gagged or have their first amendment rights violated by a ban of DTC advertising of prescribed medicines. Companies a routinely banned from directing certain types of advertising to inappropriate audiences who do not have the right to purchase a product of their own volition (i.e., companies are not permitted to target alcohol or cigarette ads to minors & cig ads are not allowed on tv). Since patients can not legally purchase prescription products without a valid prescription from a licensed healthcare professional, a ban on advertising to those who can not prescribe would be legitimate and constitutional.
Atlex
Chris,
I support free speech by pharma companies (and everyone else)and trust that fair trade and tort laws will take care of misleading communications. Do I believe in unfettered communications–absolutely not! For instance, a person shouldn’t be able to yell fire in a movie theater (unless there really is one). In addition, other communications that represent a clear and present danger, I believe, can, within the bounds of the Constitution, be restricted by law . I don’t believe that DTC represents such a danger. A potential user cannot purchase immediately based on what he or she sees in an ad. They must go through a professional who has the legal and professional obligation to make the ultimate prescribing decision.
As for off-label promotion, I do believe that restrictions limiting this can be acceptable, but that an outright ban is unconstitutional. The WLF challenged this a number of years ago; thus, currently, companies are allowed to communicate on off-label indications, so long as they follow very strict guidelines.
As for old cranky’s comment, I’ll first point out that the courts have determined that minors don’t have the same protections as do adults. I have issues with this, bu accept that certain communications to minors can be banned. As ofr the rest of his arguement, I’d suggest that all other advertising is far more dangerous since there’s nothing to stop a consumer from acting on the desire to purchase harmful products–high fat foods, dangerous toys, etc.
BPW
Altex,
The problem with off-label is that the Big Pharma companies just can’t follow the guidelines. Being driven by unsatisfied greed, they just can’t help themselves. Money, money, money - give me more.
As for DTC, I think the comapnies should just give it up. In the rest of the world, they’re allowed to provide patient education regarding medical disorders. This would be best for the US as well. Then the drug companies would actually be providing a public service - how incredible. DTC campaigns just cause problems for healthcare practitioners - especially physicians and pharmacists. The Big Pharma drug companies should leave the prescribing to the descretion of the doc and let him/her decide waht’s best for the individual patient.
Bob
Truth-You and the rest of the crusaders are making the claim.
When a person makes a claim, they are supposed to prove it.
::shakes head::
Truthman
Bob
Truth-You and the rest of the crusaders are making the claim.
When a person makes a claim, they are supposed to prove it.
::shakes head::
.. Ive backed up all my claims..
Can’t say the same for the pharmaceutical industry most of teh time though…
Womenhealth :: Rowing Aground - More on Dr Jarvik’s Misleading Advertisements
[...] - See also coverage by Ed Silverman in the PharmaLot blog, (also here) and on the WSJ Health [...]
Rowing Aground - More on Dr Jarvik’s Misleading Advertisements | Womenhealth
[...] - See also coverage by Ed Silverman in the PharmaLot blog, (also here) and on the WSJ Health [...]
jim
I have been on Lipitor going on 12 years with NO side effects…I was put on Lipitor long before Dr. Jarvik started doing his ads for the drug…granted the advertisement could be more research oriented and that a cardiologist should be enlisted in the ad…but I do not see the “falter-all” re Jarvik…Just one more thing to complain about…lighten up!