• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Industry-Doctor Ties Under Microscope

Posted on: Thursday, 27 October 2005, 18:00 CDT

By Sheryl Jean, Pioneer Press, St. Paul, Minn.

Oct. 27--A federal investigation into the three biggest heart-device makers and their efforts to promote use of their products is shining new light on the cozy relationships between manufacturers and health care providers.

"The device industry has always flown a little below the radar screen. It's always drugs that have gotten attention," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics in Philadelphia. He has heard of kickbacks paid for the use of products in the pharmaceutical and catheter equipment industries, and he suspects the heart-device field is no different.

"The biggest sales effort at medical meetings are device people, and that gets into controlling the makeup of the meeting," Caplan said.

It used to be worse. Jeffrey Kahn, director of the University of Minnesota's Center for Bioethics, said medical companies have dropped the practice of taking doctors on expensive junkets that ostensibly were conducted to offer education but often seemed more about skiing or golf.

"The same kinds of issues arise in less obvious ways," he said.

The relationships between the device makers, doctors, and hospitals can be complex.

It's common practice, for instance, for device company representatives to attend patient implant surgeries and play an active role in setting the device codes at a computer while the doctor is operating. Company representatives typically are available to answer technical questions during annual patient checkups. And the manufacturers often provide technical seminars on existing and new products.

Dr. Michael Thurmes, a cardiologist and president of the Minnesota Heart Clinic in Edina, said he hasn't received any incentives other than a pencil in the past several years. Perhaps once a month, a device maker will pay for lunch at the clinic for the medical staff to explain a new pacemaker, he said.

Thurmes sees no conflict here. "The device representatives know their devices better than anyone else," he said. "The representative is following the physician's directions."

Attending educational programs is considered OK, while cash payments would be wrong, said Dr. David Luehr, president of the Minnesota Medical Association. "It should be primarily related to improving the health of the patient," he said.

Several hospital networks and doctors groups in the Twin Cities said they follow ethical business guidelines of the American Medical Association or AdvaMed, a national trade organization for the medical device industry.

For example, a code of ethics at Allina Hospitals and Clinics system, which includes United Hospital in St. Paul, bars employees from accepting items worth more than $50, said Colleen Kingsbury, a spokeswoman for Allina.

Even so, savvy sales representatives know how to build friendly relationships with doctors, said Dr. Bryan A. Liang, executive director of the Institute of Health Law Studies at California Western School of Law in San Diego.

They stop by doctors' offices for introductory visits and buy pizza lunches for the staff. Pricey medical books and European vacations under the guise of educational seminars are not uncommon, Liang said.

Thurmes and other local doctors say time pressures mean they often rely on company-provided research and technical updates. Dr. Stuart Adler, chairman of the 31-physician St. Paul Heart Clinic, does pre-market research with all three of the local device makers. The companies pay for testing of the prototypes, but he says the clinic just about breaks even on the projects.

"That's how we find out about new devices and find glitches," said Adler, who had already worked 80 hours by Wednesday. "If I spent all day with a company to get a study started, (I might get) lunch and dinner. Where you draw that line will always be a little gray. I don't think they're trying to influence me. They want access to an honest doctor who's going to give them feedback."

Little Canada-based St. Jude's 1,500 sales representatives operate under a code of business ethics regarding their relationships with medical professionals and customers. It also provides a hot line to report possible violations.

"At St. Jude Medical, we are very diligent with respect to our code of conduct," said company spokeswoman Angela Craig. The code prohibits the company from making any payment or donation to a doctor or customer in exchange for use of its product; paying for a relative or friend of a doctor or customer to accompany them on a trip; pay for a doctor or customer to take a "side trip" in connection with a corporate trip the company is paying for; and provide gifts or entertainment to a customer or doctor that are "extravagant."

Even if sales tactics influence doctors, it's questionable whether it matters. Local doctors said that about 80 percent of the time, it doesn't matter whether a Medtronic, Guidant or St. Jude product is used. In perhaps 20 percent of cases, one brand might be better over another because of the patient's physical ailment. In addition, some patients request a certain brand and some doctors have a preference, physicians said.

Hospitals have a huge say which medical devices are used. Some try to control costs by negotiating prices with manufacturers in contracts that favor one device maker over others if there is no clear medical preference or difference in product quality. Physician groups usually are included in contract decisions.

Tim Huber and Gita Sitamariah contributed to this article.

-----

To see more of the Pioneer Press, or to subscribe to the newspaper, go to http://www.twincities.com.

Copyright (c) 2005, Pioneer Press, St. Paul, Minn.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: Saint Paul Pioneer Press (St. Paul, Minn.)

More News in this Category