Boston Scientific takes its show on the road

MILWAUKEE -- In the world of medical marketing, there is the company pen, the notepad, the drug sample, and the free lunch.

And then there is Boston Scientific's SimSuite bus, the shiny blue executive coach that recently pulled up to the Aurora Sinai Medical Center. Inside, a life-size plastic patient complains, dies, and is dramatically revived several times a day with heart-repair devices made by the Natick company.

The bus, a mobile operating theater, logs thousands of miles a month teaching doctors how to use the growing arsenal of tools from Boston Scientific Corp.'s $5 billion-a-year cardiovascular business. Each day, up to eight of them are trained to perform bloodless heart procedures on a computerized mannequin nicknamed ''Simantha." It is part traveling billboard, part high-tech classroom.

''Any time it comes, I sign up," said Dr. Sepideh Kazemi, a 38-year-old Wisconsin cardiologist who spent an hour on the bus trying to clear Simantha's clogged arteries with catheters, expandable balloons, and even a diamond-tipped drill. ''It's very close -- you feel like you're doing a real case," she said.

Brand-building on wheels has a long tradition in the consumer products business -- there is a toothpaste-shaped Crest truck, a purple RV for Prilosec heartburn pills, and most famously the Oscar Mayer Wienermobile, on the road since the 1930s. Marketing for medical devices, by contrast, has traditionally been conducted quietly in doctors' offices, research journals, and conferences.

But as the medical device business grows larger and more competitive, and salespeople compete for scarce one-on-one time with doctors, companies are searching for more creative ways to reach the specialists who use their products.

The bus ''kind of creates an event, a sense of urgency," said Amy Shannon of Medical Simulation Corp., the Denver company that developed the simulator and leases the bus to Boston Scientific.

Neither company will say how much Boston Scientific pays to lease its two buses -- a twin roams Eastern states -- but both say they are pleased with the results. Since starting the program with one bus in 2003, Boston Scientific says, more than 3,000 doctors and staffers have come aboard for training.

''When you have a new technology, and it has techniques you have to master, the opportunity to experience those in a totally risk-free environment is pretty good," said Amy Charette, who runs the bus training program for Boston Scientific.

In Milwaukee recently, doctors at the heart division of the Aurora Sinai Medical Center arrived at work to find the 35-foot bus in the visitor's parking lot. Its exterior was covered with Boston Scientific slogans and a photograph of a cardiology team huddled over a patient. Inside was a mockup of a cardiology catheterization lab, complete with a photo-mural depicting a towering X-ray gantry.

The heart of the bus is an operating table with a mechanical patient built by Medical Simulation. Its head is borrowed from a resuscitation dummy; its body is a plastic shell draped in blue surgical cloth. Through a patch of exposed flesh, doctors thread the long, narrow devices they would use to repair a patient's blood vessels. A powerful, computer-driven system grabs the tools and, beneath the doctors' fingers, creates the illusion the devices are twisting and threading through arteries.

Just as in a real cardiac-catheterization lab, doctors track the procedure by keeping their eyes on an X-ray screen. The doctor has free rein to push a drill harder, to inflate a balloon too far, to increase the dosage of a drug, or to make mistakes.

''We frequently have physicians say they start sweating during a complication," said Katrina Ruff, logistics manager for Medical Simulation. ''Their heart starts racing. We have to remind them that it's not real."

Such high-tech simulation is playing a growing role in medicine, with hospitals and medical schools developing their own training systems for surgery, emergency room crises, and basic consultations. In some cases, the artificial patient may sit up, bleed, and even talk.

Simantha has a limited vocabulary -- occasionally she blurts ''my chest hurts" to indicate a doctor has been blocking a blood vessel too long -- but in many ways the experience is deeply realistic. Above the table, the heart depicted on the X-ray screen appears to be in constant motion; another screen keeps tabs on heartbeat and blood pressure. Doctors can also change the mix of a drug cocktail being pumped into the patient's veins, regulating blood pressure and pain.

As Kazemi worked, an experienced cardiology nurse handed the doctor tools and subtly offered suggestions as the computer threw her a series of tricky problems.

''The patient complains of chest pain, the blood pressure drops, and you can see the patient die," Kazemi said later. ''It makes you more cautious on real patients."

Boston Scientific considers the buses, along with another simulator at its Minnesota training center, to be part of its official regimen for training doctors on new tools. The simulations use only a fraction of the 7,000 different devices made by the company's cardiovascular division, but information on its flagship product -- the Taxus drug-eluting stent, which accounts for nearly half the company's sales -- is everywhere inside the bus. Even the mannequin's surgical cap is imprinted with a Taxus logo.

The company says it does not track the bus's impact on sales because its purpose is primarily educational. But it has become a key part of new product launches. Last year the bus was used to help introduce a device called the FilterWire EZ, which catches clots before they can lodge in blood vessels.

''We believe that if you have good education, and physicians' confidence is improved, then it should help adoption," said Charette.

Chief operating officer Paul LaViolette said it was the first medical-device launch ''where medical simulation was the primary mode of physician training."

Among other distinctions, Boston Scientific's mobile lab may also be the only bus to have been reviewed by the Food and Drug Administration. After including the mobile simulator program as part of a new-product application to the FDA, regulators asked to see the bus in person.

When it pulled up to FDA offices, said Charette, word spread, and soon more than a dozen government staffers had filed through. The FDA's cardiologists didn't go easy on Simantha. ''They wanted to see what the limits are, and what they can do," said Charette, and they found it ''very realistic."

''They purposely oversized the stent, perforated the artery, and ultimately flatlined the patient," she said.

Keeping the bus on its constant schedule -- five days a week, with long interstate hauls over the weekend -- requires two rotating crews who spend two weeks on the bus and two weeks off, staying in hotel rooms along the way. The vehicle has a generator and a glass-doored front lobby with stools and a computer workstation, but no chairs or bunks.

Its success means that now there are imitators. Minneapolis-based medical-device maker Medtronic Inc. owns a pair of 80-foot tractor-trailers with labs for doctors to practice implanting pacemakers.

But the SimBus still cuts a distinctive profile. The company drives it to more than a dozen trade shows and conferences a year. Last month, at an annual conference of interventional cardiologists, scores of medical-device companies set up booths in the Washington, D.C., convention center. They handed out brochures and luggage tags; one company even had an espresso bar. But Boston Scientific had the only bus.

Barb Polman, who schedules the bus for the company, is a marketer who specialized in creating trade show exhibits. She interviewed for a job at Boston Scientific, and found herself in charge of the transcontinental operating room.

''Never in a million years did I think I'd be arranging for a bus, but it's wonderful," Polman said. ''It's not an average bus."

Stephen Heuser can be reached at sheuser@globe.com.