FROM THE EDITORS
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First, the part that’s justified: The Star Ledger of Newark, NJ, reported in May that the federal government investigation into alleged kickbacks by five orthopedics companies is nearing an end. It stated that four companies—Biomet, Smith & Nephew, Stryker, and Zimmer—have agreed to (or are close to) a settlement. Such a settlement could include hundreds of millions of dollars in fines and the installation of a federal monitor. The fifth firm, Johnson & Johnson’s DePuy Orthopaedics, was said to be holding out.
According to the report, “the evidence includes statements from prominent doctors around the country.” They allegedly accepted lavish vacations, gifts, and “consulting fees” as high as $200,000 a year “for little or no work.” The conduct likely took place before AdvaMed’s Code of Ethics was created, but this is just the type of thing the code is designed to prevent.
If true, that kind of conduct has no place in medicine, and it gives a bad name to all the doctors and device companies that conduct business honestly. It will negatively affect public and media perception of the industry. And it could turn lawmakers and regulators against industry, too.
It also provides an excuse for lazy journalists and critics to include the device industry when discussing questionable practices in the drug industry. That happened during coverage of a New England Journal of Medicine (NEJM) article that said nine in 10 doctors accept gifts from drug and device companies.
Most reports delineated the practices that pharmaceutical sales representatives engaged in. But they also implied that device company reps participate in them too, without citing any examples.
These reports ignore that device development is necessarily an iterative and collaborative process between doctors and device companies. Doctors have to be able to use the device for it to work—and thus there are legitimate reasons to have doctors involved in product design, or serve as consultants. The same is not necessarily true for drugs.
But there are legitimate reasons for sales and marketing personnel to have ties with doctors, too. Among those who agree is Thomas Stossel, a Harvard Medical School professor whose comments were buried at the end of a Bloomberg News piece on the NEJM report. He attributed 85% of medical progress to the work of drug and device companies. “The ties between industry and medicine should be encouraged,” he said. “The corporate involvement in medicine is a natural, evolutionary adaptation to opportunity. Products beget more products. They need to be marketed, because doctors need to know they exist. It’s a natural, symbiotic relationship.”
In a comment posted to MD&DI’s blog (www.devicelink.com/mddi/blog), Severt Jacobson, MD, found much of this coverage to be overblown too. Moreover, he found it somewhat insulting to doctors and device-company personnel.
“I would hope that an occasional meal, a calendar, and a unique ballpoint pen would not cause me to throw my ethics, 10 years of medical training, and 30 years of experience out the window,” he said. “I suspect the studies done…were not of persons with at least five years of postgraduate medical training earning more than $150,000 per year. The medical group in general comprises free thinkers, and [those that are] generally very individualistic. This is why we have no strong physicians’ unions or unified political clout.”
Doctor-device company arrangements do have the potential for abuse. That is why AdvaMed’s Code of Ethics exists. Whether the code is enough of a deterrent—and Jacobson later in his comment suggested it might not be—is for another discussion. But it is an indicator that the device industry is taking steps to help prevent serious abuse from happening again. It’s time for the media to stop assuming that these types of arrangements will always lead to abuse.
Erik Swain for the Editors
