Updated with comments from Novartis and Mary Knudson–
A Novartis television commercial and advertising campaign is terrifying millions of people and provoking sharp criticism from doctors. The critics include Milton Packer, a top expert who ran the main trial testing the company’s big new heart failure drug, Entresto.
The ad depicts a middle-aged man in an easy chair reading the newspaper, oblivious to a rising flood that threatens to drown him, though his dog, climbing onto a couch for safety, expresses considerable anxiety.
With a background of ominous sounds, including a beating heart and the dog’s whines, a narrator darkly intones:
With heart failure danger is always on the rise. Symptoms worsen because your heart isn’t pumping well. About 50% of people die within 5 years of getting diagnosed. But there’s something you can do. Talk to your doctor about heart failure treatment options. Because the more you know the more likely you are to keep it pumping.
The website and the ad don’t mention Entresto, but there can be little doubt that this new campaign is designed to get patients to talk to their doctor “about heart failure treatment options.” Entresto, the new heart failure drug from Novartis,is the only major heart failure drug still under patent protection; the rest of the major heart failure drugs are off patent and available as inexpensive generics. The ad and the campaign are part of a “disease awareness” campaign, often used by pharmaceutical companies to drive patients to new products without actually mentioning the name of a product.
I first saw the ad on the NBC Evening News on Monday evening. The ad, and a lot of supporting material, can be found on a Novartis website: Keep It Pumping.
Milton Packer (Baylor University, Dallas), a leading heart failure expert, has been the most prominent advocate of Entresto. But he is deeply disturbed by the ad:
“This ad really disturbs me. It is alarmist, and I am not certain that is a good thing for patients.
There is a good reason to tell patients that there may be new options for them for the treatment of heart failure.
But the role of a new treatment for heart failure is part of a discussion that first needs to take place among physicians before the message is delivered to patients.
I have been a strong advocate for angiotensin-neprilysin inhibition (one of the new approaches to heart failure). And I have written a number of position pieces that express my views. My friends may or may not agree with me, but that is how the process should work. The cardiology community needs to digest the data and have a debate. That is what is going on now, and it is very useful.
After that debate has taken place and we collectively find a good path forward, we can deliver that message to patients. Delivering such a message to patients BEFORE the debate has occurred is just going to cause confusion.
And that makes me really uncomfortable.”
Vinay Prasad (Oregon Health and Sciences University), was an early skeptic about the overall effectiveness of Entresto, but he criticizes the ad on another basis entirely:
I find the ad to be horrifying. Obviously, it has been crafted to evoke fear and uncertainty. In all honesty, even I felt rising terror as the water level rose, and the inevitable loomed near. I think if there is any proof that our nation was misguided to pursue direct to consumer advertising this is it. We are only one of 2 nations that allow this sort of manipulation of the practice of medicine. The ad should earn every advertising award; it should also earn public outrage.
Ethan Weiss (University of California at San Francisco) became concerned when he saw the ad on Monday night:
I think it’s irresponsible to play on the fears of patients in such a brazen and manipulative way. It is potentially terrifying to them, their families and friends and could have a tremendous negative impact. They should be ashamed.
Novartis has placed a lot of expectations on the success of Entresto. Many experts believe the drug will become a multi-billion dollar blockbuster, but, as I reported last week, it is off to a very slow start. It is unclear whether the company will benefit from this campaign or whether it will suffer from a backlash.
It is also worth noting that the terrifying statistic used in the ad– that half of all heart failure patients die within five years– is no longer accepted by heart failure experts. It is based on Framingham data that is more than 30 years old and reflects neither the changing heart failure patient population not any of the effects of new treatment advances. But there is another common heart failure statistic– and this one has the virtue of being largely true– that might be relevant here. This statistic is that about half of all heart failure deaths occur when the heart abruptly ceases beating (sudden cardiac death, or SCD). It is not hard to imagine that this ad will increase the incidence of SCD.
Update:
In response to questions about the advertisement Novartis sent the following statement:
Our goal is to create awareness of heart failure so people with the condition can take action to live longer and healthier lives. We developed the Keep It Pumping ad with those intentions – to educate people and facilitate patient-physician dialogue.
According to stats published in NEJM and JAMA, about 50% of people diagnosed with heart failure die within five years. This is widely cited – by organizations like CDC and AHA.
Update 2:
Mary Knudson, a heart failure patient advocate and author of Living Well with Heart Failure, the Misnamed, Misunderstood Condition, sent the following comment:
Terrible ad. There are very effective treatments for heart failure already on the market. Many people diagnosed with heart failure get their heart failure under control as I did and live long lives. Just because you are diagnosed with heart failure does not mean you will ever die from a heart condition. Shameful for a drug manufacturer to try to scare people with active heart failure who are at risk of sudden death just to try to sell a new product.
Thank you! I run a support group on Facebook ,” Congesstive Heart Failur – CHOOSE SUCCESS ” and have had members email them regarding this awful, insensitive, horrifying commercial.
Why does your group find the ad so offensive?
This ad is an accurate depiction of congestive heart failure. My husband has congestive heart failure and it does seem to creep up, until all of a sudden he can’t breathe and has to go into the hospital. He is now taking entresto and it has been a slow go but he has not had to be hospitalized. He has a very good cardiologist and has actually done very good for 5 years.I do not find the ad offensive at all.
Tell your husband to hang in there. I started heart failure at 62 now 80.
I want to say thank you for your post. To see you were diagnosed with heart failure at 62 and are now 80 has lifted a heavy burden from my heart. My husband is 79 and was just diagnosed with congestive heart failure and was just placed on Entresto when nothing else was helping. This gives me hope that may have my husband for longer than I was initially told. The night 7 weeks ago when he was rushed to the ER I was told he has less than 2years…..first episode ever of fluid retention on his lungs and abdomen. Since then his doctor has prescribed Entresto. I must say he tells me he feels better. Before Entresto he could not stay awake for more than 5 to 0 minutes at a time all day. Now he is awake and alert all day long. No napping. But, he is still very weak because at some point in life he had a major cardiac occurrence. Only one third of his heart is viable. I will be looking for you site on Facebook to follow your discussions. Thank you.
I took this entresto and it was by far the worst thing I’ve ever taken! Within 1 hour I felt like I couldn’t breathe at all. This was the scariest thing I’ve ever experienced. I can’t understand how a company could sell this crap.
Scared the heck out of me and I suffer from chronic anxiety in addition to heart failure diagnosed 6 years ago. I watch a lot of TV due to my condition and have had terrible dress since seeing the stupid phony commercial. Novartis is going straight to he’ll for making me suffer like this.
I’ve had heart failure for 10 years. I’m very active and go to work everyday. Novartis should try to take a more positive approach to their advertising instead of using “scare tactics.”
Stop your horrifying commercial! How dare you use scare tactics to promote your product! I have heart failure and your damn commercial frightens me! STOP IT NOW!! Dr. Natalia Rushing!
The pharmaceutical companies are detestable. These bastards should get every disease they claim to cure with the side effects to boot.
The Entresto study was designed in such a way as to pretty much guarantee that drug would statistically look better than the comparison drug Valsartan. It is a scam of the highest order. This is an example of how the medical industrial complex operates.
I would cease referring patients to a cardiologist who prescribed this drug.
Thank you for your insight. I am a 63 year old heart failure patient. I was diagnosed with diastolic heart failure at age 60 following a heart attack and stent placement. I do tend to be symptomatic but have a number of comorbid conditions. That said, the Entresto commercials ,I have seen several do scare me and I see them daily so am hit with a daily reminder that ” tomorrow isn’t a given “. To make it worse, the one I am seeing now shows grandparents and grandchildren to remind me I might have little time left with my precious grandson. If this drug is this effective and correctly marketed to Doctors, what Dr. Would not evaluate every heart failure patient he or she had for use of this new drug. Also, I recently found out that while my excellent cardiologist has not discussed this drug with me, I am on Valsartan, the comparable drug.Also, for the record, I hope you would agree with me that any heart failure patient who is aware of their diagnosis and has a general understanding of what that means in regards to health and prognosis would respond to a simple ad that said there is a new drug that may improve your health and symptoms and longevity . Thank you.
How dare this company put fear into the children of heart failure patients. There are those age 40 and under with heart failure and children in grade school and high school who have to explain that mom is not dying tomorrow, unlike the commercial says and reassure them that currently, Mom’s ejection fraction is on the positive. The conversation between Mother/father and child about chronic disease is one that should be had with the family and the cardiologist, NOT an insensitive commercial causing kids to cry and ask Mom why she didn’t say she was dying tomorrow? And to know the point of the commercial is only about money? Only about selling more drugs by insiting fear to invoke requests for this drug at the doctor? You people are horrible.
I agree completely. I’ve been a heart failure patient for over 10 years. I continue to work two jobs daily. They should show heart failure patients leading active lives and taking the proper medication. Their ads are very offensive to me.
Speaking of terrifying awareness (oh please!) campaigns, I’ve been slamming Canada’s national Heart and Stroke Foundation ever since they released their 2016 Report on the Health of Canadians: The Burden of Heart Failure https://myheartsisters.org/2016/03/13/two-ways-to-portray-heart-failure-one-of-them-works/
The black and white illustrations throughout this report are absolutely appalling – feeble old people slumped in wheelchairs, apparently waiting for imminent death by heart failure. I contrasted this “awareness” approach to the American Heart Association’s decision to feature twin sisters Shaun Rivers and Kim Ketter, both nurses from Richmond, Virginia, each diagnosed with heart failure during the same week when the twins were just 40 years of age.
I applaud the AHA decision, and am filled with despair and frustration over that of the HSF. But honestly, Larry, what can we expect when physicians cannot or will not come up with a better alternative to the unfortunate and alarmist words “heart failure” in the first place?
regards,
C.
I agree that this advertisement is not only horrific, but makes people uncomfortable, just as the side effects that are mentioned. Heart disease is a real problem and there is nutrition and medications available. Please try other advertisements.
I personally do not see anything ofensive or incorrect in that advertisement. It’s quite good to alert people about the dangers of a non treated h. Failure. I applaud this ad. We need more like this.
I alerted Entresto to this ad. I was scard out of my wits. Then came a survey on line and that was disheartening also. I could not finish the survey. It was too upsetting and pointed toward them making money. I was angry and told them so. Novartis probably laughed all the way to the bank after they hung up from me. This drug is still too new to see if it is the Miracle drug they are hoping for. I am not convinced, yet. My BNP level has not gone done whatsoever. And this med can place a Medicare patient on the D plan in the donut hole very quickly early in a given year. Been on this med now for a year. God Help Us All.
This ad is dissuading and totally sick???? Don’t treat people like pay checks???? This is a sick and non caring advertisement. Tell elderly human that there time is up is really very sick!!! you will do anything for money. You are very sick and greedy? Your future is inconsequential? .
My mom was just diagnosed with heart failure after an extensive hospital stay. Viewing this commercial literally had me in tears thinking the worst. So happy the ” no hope, unless commercial ” no longer exists.
I’ve had heart failure for 11 years. I work full time and run a profitable business. Never worked harder in my life at 59. I told my cardiologist I hated that commercial and she said it was not accurate anyway. It’s a shame they use such scare tactics.