Medical devices and pharmaceuticals: differences in public acceptance.

In the past 15 years, rapid technologic advances have introduced medical devices for clinical use that have transformed the care of patients with chronic diseases, especially heart disease. These devices have become truly lifesaving, and their effectiveness has been demonstrated in randomized clinical trials and cost-effectiveness studies. At the same time, a remarkable number of pharmaceutical agents with new actions and capabilities have also been introduced into clinical use. These new compounds have altered the practice of oncology and the care of patients with hematologic malignancies, sometimes with significant improvement in survival. There have been other drugs introduced to manage chronic diseases that alter quality of life but do not usually threaten survival. Recent problems related to the COX-2 anti-inflammatory drugs and ongoing controversies associated with them have raised public awareness; however, there is even more concern about device failures and recalls that have occurred during the same time frame. There is limited information as to why there is such an apparent difference in public opinion toward adverse drug events compared with device problems that lead to advisories or recalls. Among possible reasons are that an implantable device that requires a catheter-based surgical procedure, with its need for hospitalization and detailed explanation about all the potential risks, may be emotionally and intellectually processed differently by a patient/family compared with having a change in prescription from one drug to another.