Planned Obsolescence ?

There is an interesting report in the UK press this morning where comments from two UK cardiologists are reported.

Both state that the business model for PM manufacturers is not working in the best interests of pacemaker patients.

Batteries used in PMs last usually between 6 and 10 years, then the PM is replaced and that is where the manufacturers make their money. The manufacturers are refusing to use batteries with a much longer life ( and these are available apparently ) in their pacemakers/ ICDs because they have no financial incentive to do so.

These two cardiologists state that it is wrong that patients are being exposed to surgical risk by far more frequent PM replacements than is necessary.

Any marketing experts out there ? What is the solution for this where neither manufacturers nor patients are the losers ?

Ian

13 Comments

otoh

by Tracey_E - 2016-02-05 01:02:06

The one I got the first time doesn't do half the stuff the new ones do. When I got that first one, all I had was av block so it worked great for me. Now, throw in svt, chronotropic incompetence and the occasional random plummet and I'm a programming nightmare for my rep, but the pacer can handle it. Some degree of obsolescence might be a good thing. They don't make huge strides in pacing technology, but there are advances, most notably in rate response.

Ian, sorry about that! I guess you don't want to talk about computers and cell phones, either? ;P

Wow

by Suz2015 - 2016-02-05 01:02:51

Back when my Dad was in college (early 40's), he once borrowed a car that got 50 miles to the gallon....no fooling.
Now they are so proud of the fact that cars these days "can get up to 40 mpg"....considering the weight differences in cars...not such a great deal !!!!
I!
They dumped the "rotary engine" that Mazda came up with
as well.....(too efficient !)
I would love to know that the battery would last 20 years instead of the 9.5 they say I have left, (implant 11/2015)!

Don

by IAN MC - 2016-02-05 03:02:29

Your points are well made but forgetting radiation for a moment ,does it not worry you that right now there are nattily dressed marketing executives having meetings in the various pacemaker companies

Subject of Meetings : How do we sell more pacemakers ?

Thrusting young executive at the back suggests putting in batteries with much shorter shelf-lives . It doesn't matter about the patients !!! Are we sure that this is not happening ?

I could write a book about the ways pharmaceutical companies increase their sales . Not selling enough asthma drugs ? Answer : Persuade the Drs that asthma is under-diagnosed

Not selling enough blood pressure pills; Answer : Persuade the medical profession that anything over 120 / 60 is dangerous.

Not selling enough statins Answer : Persuade governments to financially incentivise GPs to prescribe them. Maybe we could add them to our drinking water ?

I am certain that commercial considerations are more important than patient needs in the world of pacemakers.

Ian

I bought in ....

by donr - 2016-02-05 03:02:55

... on the argument.

Start by Googling "Plutonium batteries" for a lengthy discussion of this subject & its technical feasibility.

When I got my PM in Feb 2003, I was talking w/ my EP about batteries. He told me at that time that they could make a "Plutonium Battery" that would last 50 yrs, but that lifespan was so long that it would outlast the technological lifespan of the PM.

Now, read that "Plutonium Battery" as you would the word "Bandaid" - a generic term for some sort of power source using radioactive materials. Pu (Chemical shortcut for saying Plutonium) is NOT a particularly user friendly material, & its supply is quite limited. There are all sorts of practical technical & sociological reasons why THAT material is a non-starter.

But - there are all sorts of other radioactive elements that could be used. The technology is there, of that I am confident. But can you imagine the sociological barriers to using RADIOACTIVITY in an implantable medical device? if you think that the furor over GMO food sources is bad, throw out there "Radioactive" if you want to see some fireworks from the lunatic Luddites of the world.

But, to give the Devil his due - did you know that a significant percentage of the smoke detectors in residential use have radioactive sources for detecting smoke? And - they are sold off the shelf in your local DIY store! If my memory serves me correctly, it is Americium that is in them.

I found this quote in a website discussing radiation powered smart phones - it sums up the sociological issues quite succinctly:

"Ultimately, even if beta radiation can be quite easily contained, I doubt we’ll ever see commercial nuclear batteries. Those headlines about exploding lithium-ion batteries are already scary enough; I can’t imagine Apple or Samsung will ever open themselves up to even worse headlines/lawsuits. (“Smartphone owner dies from acute radiation sickness after dropping his phone”.) There’s also the distinct possibility of terrorists creating a dirty bomb from all of that strontium-90 (which itself isn’t cheap, incidentally)."

Let's talk electronic evolution for a moment.

The first transistors came about in 1947. By 1959 the US Army was using transistorized guidance packages in air defense missiles (Nike Hercules). That's a mere 12 yrs from concept to practical use. In 1963, I was in grad school, working on an MS in electrical engineering; we had a alligator shoe wearing salesman from Motorola speak to us about their use of semiconductors in radios. He set a brand new 9 transistor (Gasp!) pocket radio on the table at dinner w/ a bunch of us students & while reaching for it, I managed to slop some sort of staining edible substance on his necktie! (You determine which was more memorable - the radio or the clumsiness at the table). That same year, I took a course taught by a dinosaur prof & our Dept head on electron tubes (Valves for Ian). This man knew all the giants of tube development in the 1930's. At the same time, the first course in transistors was being taught by an engineer still just barley old enough to shave.

Over the next 10 yrs, I witnessed the total disappearance of classes on electron tubes from college curricula & the ascension of courses on not just transistors, but integrated circuits that were microscopically small. Upshot is that by the 1980's, when our #1 Son earned his EE degree, We could not even communicate because technology had radically evolved so far & so fast that neither of us understood what the other was talking about.

Look at the evolution of PM/ICD's from the 1950's till today. We have gone through technology starting w/ the first PM that my grandmother hosted in 1970 that had little adaptive capability, to the leadless device that Running Mamma had implanted just last year. Look at the changes in technology (Principally RR technology) that Golden_Snitch writes about for the PM's that she has had in the relatively short period of her life.

Just since I got my first PM in Feb 2003, the MRI capable device has come along - that's a mere ten yrs (Roughly).

You overlay a 20 yr battery life span over just the subjects I've mentioned & you can see that a significant number of hosts would be harboring devices of somewhat questionable capability. Look at the resistance to changing out old style non-MRI PM's & leads that exists.

Ian: TV's, electric toasters, kettles - there I did it!

You are completely correct about the quality of those devices. I can recall a period of time when the quality & reliability of TV's manufactured in the US was so BAD - so ATROCIOUS - that just about every one of our manufacturers went out of business. The aforementioned Motorola finally got the big picture & went to what they called "6 sigma quality control," but it was too late & the center for solid state electronics manufacture shifted to the far east. It was not necessarily planned obsolescence, but pure & simple stupidity & poor business decisions. Pile on tremendous technological advances, & devices do become obsolete. Look at the evolution of cell phones. My cell is smarter than I can keep up with at age 79 1/2. I need my granddaughters around to help me w/ the infernal device.

In the FWIW Dept - we have a pair of flat screen TV sets at home. Both are plasma screen devices. One is ten yrs old & we got it from our Daughter who upgraded from 2D to 3D capability. At the same time, she upgraded from a 150 lb set that took three people to hoist up onto the wall to a set the same size that one person could get up there. The second is 8 yrs old & both are plugging along very nicely. Incidentally - plasma devices are no longer available - LED & LCD screens are now the common technology.

As a last citing of what happens w/ technology advances - consider what happened in East Germany when the Wall fell. Cars in East Germany were dominated by the Traubi & Wartemburg, a pair of technological dinosaurs. W/i just about two yrs they disappeared from the roads, to be replaced by Mercedes, BMW's, Fords, etc. I was in Dresden for business in 1992 & kept looking for a Traubi - I really wanted to see what one looked like. Finally I asked my host where I could find one & he told me to quit looking - they were all gone. Finally when I was two days from going home, I not only saw, but rode in a Wartemburg.

What I witnessed was human nature & the desire for improved products replacing government control over consumer goods & stifling advancement.

Unfortunately, there is a quantum leap between chemical & nuclear battery technologies.

Chemical batteries top out at about 10 yrs, max, for lifespan - & that depends on how much demand is placed on them. They are the weak link in the system, followed by the leads & finally the data processing part of the PM/ICD.

Nuclear batteries can practically go for 20 yrs & really are not influenced by the electrical load, because their life span is dictated by the half-life of the radioactive source. Their main impediment to greater use is sociological, not technical.

Ian, would you be happy to accept a nuclear battery? Probably you would, but I seriously doubt that the vast majority of the device hosts would. I'd like to see a poll taken on that subject w/i the PMC. Blake, how about it?

Meanwhile, chemical battery technology creeps ahead at a glacial pace.

Suze: On the Mazda RX series of vehicles w/ rotary engines. We owned one - an RX2, MOF. great car. Lotsa torque at low RPM. Could start moving while the engine was at idle RPM. Great car for teaching tens how to drive. Remember those days? Stick a manual transmission in it & it had so much torque that even a new teen driver didn't "Bunny hop" it when starting from sitting still. I taught 5 of them to drive.

Mazda did not invent the rotary. It is a German invention by some engineer named Wankel. Mazda was the only car company to ever develop a commercially viable massed produced rotary engine. Others tried in Europe & the US, but not w/ great success.

Unfortunately, they were NOT efficient at all. W/ the huge rotary "Pistons," it was impossible to get a seal on the sides of the rotors to get a high enough compression ratio to get decent efficiency. About 20 MPG was the practical max. We got nearly 100,000 miles out of ours before we sold it. A near record. the man who bought it realized that it was probably near the end of its life - it croaked about three months after he bought it. Side seals on rotors failed.

Tracey: You type faster than I! we said the same thing.

Donr







Ian: that's a...

by donr - 2016-02-05 04:02:24

...serious charge to make.

Such shenanigans once cost a company I worked for many millions of dollars & what was called a "Compliance Order." That meant that we had violated the "Sherman Anti-trust Law" & some executives went to jail over it.

I worked there many yrs after the violation & we were watched like hawks watch mice. If any of us so much as TALKED to a marketing person from another competing company at a conference, we were risking jail time. we could not even possess marketing brochures from other companies.

Dunno what the penalties for such are in the UK or Europe, but they are pretty darned stiff here.

Do we have any substantial indications that such events are happening? If I did, I'd blow thew whistle on them immediately. Maybe even sooner!

Sidebar: Yesterday a slick, alligator shoe wearing sales rep from a major lab service company stopped in to see Doctor Daughter in her new clinic. It was interesting to hear his pitch. that portion of medical service is pretty darned cut throat, w/ all the major players offering what appear to be rock bottom prices & rapid turn around on lab work. Daughter looked out window & commented that business must be pretty good - he drove a Jaguar sedan.

Biggest advantage for her clinic is that if she draws the blood or collects the samples, it saves her patients a trip to the local hosp for the lab work. Everyone knows what another trip to a lab facility means - waiting in another queue.

Donr

Don

Don

by BillH - 2016-02-05 05:02:28

I am just a little younger than you and also an EE and I agree with you.

As to the cars I remember that tires only lasted about 20,000 miles and that is with a couple of flats thrown in. Now days 60,000 and flats are rare. Likewise car batteries.

And cars used to have a 80-120,000 mile lifetime. Now 200,000 and up are not rare.

And that 50 mpg car did not have AC and most likely did not have a heater. And vacuum wipers that stopped when needed the most. Or maybe even manually operated.

I follow a number of EP's and cardiologist on twitter. There is not a big response to this BMJ article.

But comments are that there is some truth and things can be improved. But that it is not a scandal and is overblown.

But I did notice that there is a higher risk of infection from a replacement than from the original placement. I would have though that it was less as placing leads are not involved. I asked in one thread, but did not get an response.

But I did see the comment that there was some risk of lead damage from the change out.

Also I noted in the article that too many are replaced with there are months left on the battery.

But I see too many complaints here that they can't get replacements until the after the PM has gone into reduced functioning.

For those interested here is the original article and it did not use the term planed obsolescence. Always best to find the journal article or abstract. The press often over emphasizes part of the story or leave off critical details And often that is due to the press release of the organization that did the research.

A few thoughts on the matter

by Pacemum - 2016-02-05 07:02:09

How many people have leads that have lasted 25 years? A pacemaker battery that outlasts the life span of the leads is useless as once your leads have worn out they have to replaced.

Of course, they have the new implantable pacemakers but these are in early stages and I do not think anyone has had one of the implantable devices removed yet. As others have pointed out to make the implantable devices better they will gain knowledge and learn how these can be improved by the trials and from the people who have had these implanted.

The only infection risk from the replacement surgery is from the surgeons equipment and surroundings while the replacement surgery is taking place. Provided you are in a sterile environment and the correct precautions are taken by those implanting the risk should be minimal. The new glues to seal the wound internally and externally have reduced the risk from old stitching.

The elective replacement mode is a safety net for the patients. If you replace later then there is a greater risk for the patients of the pacemakers malfunctioning.

Perhaps the cardiologists who raised the matter are working in dirty hospitals. Maybe their hospital managers have spent the cleaning budgets on plush furniture and private gallivanting around the globe. Should we call Kim and Aggie or Panorama to investigate?

no surprise

by Tracey_E - 2016-02-05 11:02:59

Remember in the 50's when our grandparents would buy a refrigerator and it ran for 30 years? My house is 15 years old and I've already had to replace most of the appliances, both air conditioner units and half the roof. I know darned well they could make things that last longer but manufacturers choose not to. I don't know what the answer is, but it doesn't surprise me that they'd choose planned obsolescence in medical technology also. A possible answer is to charge more or try to regulate it, both of which would just cause new problems. A magic wand for greed, maybe?

How True

by Good Dog - 2016-02-05 12:02:12

Back in the early 80's there was a PM manufacturer that had developed a nuclear battery that would last over 20 years. So when I received my PM I asked why I didn't get one of those. They told me (and I read it somewhere too) that technological advances where coming so fast that they didn't feel it was in the best interest of the patient to wait that long for a replacement. So they scrapped the technology. Taking advantage of potential technological advances where worth more than keeping your PM longer.
I bought the argument?

David

Really Bizarre, Tracey !!

by IAN MC - 2016-02-05 12:02:44

I read your reply, then went to the kitchen to make myself a coffee. I was surprised by the warmish carton of milk. Yes my refrigerator has just packed up ! It is just out of warranty obviously .

Please do not mention TVs, electric toasters, or kettles
in any of your future replies.

Thanks

Ian

PS David, interesting argument but I don't buy into it., the two UK cardiologists don't either .

I don't believe that technological advances with PMs have been that rapid. I hope that Tracey finds that her fifth PM is much better than her fourth but I wouldn't bet on it.

Given the choice I'd far rather have a much longer lasting battery than have replacement surgery .

IF ONLY...............

by Tattoo Man - 2016-02-06 07:02:45


Electric Frank was still with us.....

Solar Power..

Wind Power..

Wave Power...

S++t..why not Coal Power ???

Nothing was off his radar.....this was a Guy with a tattoo of a knob that read 'from one to ten'

Frank would have Jump-Leaded off his Jeep..had there not been a handy local pylon..

So..is it beyond technology to charge our Devices while we all charge our,..largely pointless Mobile Tablets and Crap...??

With all due respect to EF..

Tattoo Man

Ruminations on batteries

by donr - 2016-02-08 03:02:19

Ian, BillH: I was really intrigued by the topic , so spent an hour or so doing some research & analysis.

I started by finding the Daily Mail article that started the discussion, then dug back & found the British Medical Journal article by Dr. dean & all the replies to his (their) article.

1) I was not impressed by the DM article. Fear mongering & sensational writing, printed to attract attention. Little factual info given, & stressed peripheral issues (infection) that need to be controlled regardless of the lifespan of batteries in PM's.

2) Dean's article in BMJ was an EDITORIAL, not subject to peer review. Now peer review, in & of itself is no true indicator of veracity. Peer revues can be as corrupt as Chicago, FIFA or Global Warming politics. All you have to do is choose sympathetic reviewers to look good - on on the reverse side of the coin, choose UN sympathetic reviewers to destroy the article. Now I don't know Dean, so I do not know if he is a real gadfly muckracker with an axe to grind against PM manufacturers.

3) I found an article in Google by a pair of Indians, written in 2006, reviewing battery technology & history. A bit long in the tooth, but I found nothing of any substance written more currently.

4) I found an article in a CIA rag about their involvement in Lithium battery development, short, but updated to 2014.

5) then I started thinking about my own experience w/ batteries for US Army use in ammunition & missiles.

These uses are totally independent of PM uses & would have no marketing weenies wearing alligator shoes & three piece suits sitting around nefariously plotting strategies to sell more gizmos. Uncle Sam has been heavily invested in "Smart " munitions since WW-II when the first generation artillery proximity fuze was developed. I don't recall what kind of battery was used, but it certainly was NOT Lithium based - that chemistry was not developed till the 1960's.

The arrival of guided missiles in the 1950's required batteries w/ significant energy storage for the tube based guidance systems - but they had to have long shelf lives. Again, not Lithium.

Then we come to the 1970's. Artillery projectiles performed all sorts of wondrous things - like scatter anti-tank mines that needed very long shelf life batteries before activation & relatively short lives after activation (Several days). These now used Lithium technology.

One of the methods to create long shelf life pre-activation was the development of what are called "Thermal Batteries." In a thermal battery, the electrolyte between the layers of Lithium metal is inert till it is literally set afire to make it molten & active. (That's just a superfluous comment - no way we can do that inside a PM).

6) The reason I wrote all that trivia about the military uses of Lithium batteries is to highlight the point that Lithium technology is the best there is, regardless of uses AT THE CURRENT TIME. Like most technologies, it started after others had reached the limit of their capabilities - like lead/acid, alkaline/Mercury/ Nickel-cadmium, etc.. There are NOT going to be any further quantum leaps in Lithium technology - all will be marginal small increases, so the PM is using the best available at present & the outlook is for increases of only a few years at best in service life.

7) I did not know this, but the two Indians pointed out that there already was a Plutonium battery back in the 70's, w/ a lifespan of 87 years. Too many problems w/ it, so it was junked. What they DIDN'T mention was several promising radiation based technologies that do not have the problems that Plutonium had. Their time in history for writing their paper was too early!

8) Unless someone comes up w/ a revolutionary chemistry based on a material other than Lithium, it looks like the next step forward might be another radiation based technology. I said that in one of my comments, but w/o much solid basis for the statement.

My conclusion - there are lotsa folks working on the next generation technology for small batteries/power sources. they just have not gotten to the point where they have practical systems. PM marketing weenies can plot all they want, but there is a use somewhere for the new power sources & they will dragged kicking & screaming into the era of longer life devices.

Cheers - hope this is good fodder for further discussion.

Don




Don

by IAN MC - 2016-02-09 11:02:15

Interesting stuff ! I am in sunny Spain at the moment ( just had to escape the UK winter ! ) and only seem to get a Wi- Fi connection every 3 days or so. I would have liked to have done some researches myself but a jug of sangria is winning !

I saw the original report in the Daily Telegraph which is far less sensationalist than the Daily Mail . I believe the concerns were expressed by two consultants from the north of England somewhere; I would be surprised if they have an anti -PM manufacturer agenda but ,as you know, anything is possible

Adios

Ian

You know you're wired when...

Your electric tooth brush interferes with your device.

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