Thursday, February 06, 2014

A letter from the University of Illinois

Here's an email I received today.  We should view this as progress, although it raises its own set of questions.  The key one, of course, is:  Will the report to the President be made public to the University community?  Another is whether the the University will avail itself of the expertise of outside reviewers, experts in medical ethics, to help review its practices, or whether it will rely solely on internal resources.  A final question is whether the University views it as appropriate that the Dean of the College of Medicine serves on the board of directors of a major pharmaceutical company. 

Mr. Levy, You may attribute the following statement to me—Thomas Hardy, Executive Director of University Relations, University of Illinois: 

 “Last month, the University of Illinois Hospital & Health Sciences System was mentioned in an advertisement for the DaVinci Surgical System, used in robotic surgical procedures at our hospital. 

“The ad, which appeared in a New York Times Sunday Magazine, pictured members of our surgical unit, each of whom was identified by name and academic degree. The ad was paid for by the device manufacturer, Intuitive Surgical. Neither UI Health nor any individual was compensated for appearing in the ad.

“We asked Intuitive to suspend the ad, and the company agreed, immediately upon learning of concerns expressed about it. Our request was based on a business decision; we were concerned that the ad was not benefiting UI Health. Out of an abundance of caution, we decided to review circumstances surrounding the publication of the advertisement.  We will use this opportunity to conduct a methodical assessment of policies, guidelines, procedures and practices, and where corrective changes are required we will take the appropriate action.

“Coordinating this review at the request of the University President will be will be the Vice President for Research. The VP-Research and the Vice Chancellor for Research at the respective campuses administer the University’s Report of Non-University Activity (RNUA) policy on conflict of commitment and interest. In addition to the VP-Research, participants in the review will include the Vice Chancellor for Research at the U of I’s Chicago campus (UIC); the University’s Ethics Office; University Counsel; the interim Vice President for Health Affairs; offices of the UIC Chancellor and Provost; the UI Hospital and the UIC College of Medicine. A report to the President on the review is due March 15."

Attached to the email was this letter:


Mark Graban ‏@MarkGraban said...

From Twitter:

So the conflict of interest would be ok if it WAS benefiting their health system??

Anonymous said...

Paul, this was in the air and represents a standard wishy washy response. I don't think this is a strong statement. Therefore I am not optimistic on the objectivity of the outcomes. We shall see.
In the meantime areas of concern remain and support my opinion that that was a weak statement. For instance
The letter is addressed to the Dean who should excuse himself until he is cleared from the concerns raised about his pay.
This is not only about this specific intuitive/dept of surgery issue. Other bigger problems remain, symptomatic of the non optimal situation and deviated culture at UIC. This is why external impartial reviewers should brought in.
Issues of MDs Credentialing seem that they will not be investigated.
There was no mention of transparency but a weak statement on accountability.
This was not a step forward but a step back.
Paul, don't give up you got more done alone in a few weeks than other have tried in years

Paul Levy said...

Well, let's give them a chance to finish their work.

By the way, though, no one ever suggested that any UIC individual was compensated for appearing in the ad, so I'm curious why that conclusion was in the email. The ad itself, though, said that some of the surgeons had received compensation from the company for other activities. The issue is whether those payments and/or other forms of company financial support created the kind of relationship that led someone in the department to approve the use of its personnel and the University's name in endorsing this company's products.

Anonymous said...

I agree with you, Paul; I was also struck by their disclaimer regarding compensation for appearing in the ad. That is an irrelevant point as it does not excuse allowing themselves to be used by a company for promotion of its product. It is telling, isn't it, that UI had to contact Intuitive to get the ad pulled and couldn't do it by themselves.

I hope the investigators get the point - that this sort of behavior would be considered unacceptable with regard to a pharma company in today's world and is just as so with a medical device company. The investigators should take the opportunity to establish a strict and comprehensive set of rules to eliminate such, apparently pervasive at UI, behavior.

nonlocal MD

Anonymous said...

Mr. Levy, I agree with the comments recently made about the response. Weak, very weak. In addition, they have swept under the rug the issue of credentialing. In my humble opinion, the ad raises eyhical questions while the issue of credentialing raises important questions about the legal process and the safety of the UIC patients.

Bob said...

I think this is an essentially poor response. First of all, it is from a minor officer. Secondly, they make an irrelevant point about not being paid for the ad - not the point, folks. Thirdly, they call revoking the ad a "business decision," thus assuring that they are not addressing the ethical dimension in pulling the ad. ("Pull the ad, Harry, but don't admit a thing!"). Fourthly, they skip well over the most important points that you have raised about conflict of interest that seem to run so deep in this institutional leadership.

I would hold no confidence at all in the coming institutional whitewash.

Makes me mad. These are the kind of guys who are ensuring that our medical care system will not be reformed. They are the heart of the problem.

Anonymous said...

This email is BS. I think if you look, you will find ISRG has had other ads its paid for featuring other hospitals and other surgical teams. I think purchasing a Da Vinci brings with it the opportunity to have the purchasers get ad support from ISRG. If you reach out to other hospitals, I think you could confirm this easily. While none of the individuals pictured were compensated directly, the effect of the ad was to promote the hospital and its surgical department.

beverly said...

The ad itself is BS, too. What modern academic medical center would say "we believe in" robotic surgery? About as far from evidence-based medicine as you can get.

Anonymous said...

Yes, anon 2:39, this is right off Intuitive's website:

"Finally, our Procedure Marketing and Marketing Communications teams can provide the support needed to build awareness of your robotic-assisted MIS initiatives and drive procedure volume. We are available to assist with strategic planning, marketing collateral and templates designed to help you develop custom marketing materials. - See more at: "

The thing is, marketing for the hospital is also marketing for the da Vinci, of course.

nonlocal MD

Anonymous said...

Paul, employees of UIC have not received any information of what has been going on lately over there. However, it is well known that employees are checking regularly your blog. Why is the CMO, Dr Pygon, not fostering a culture of transparency by sharing the correspondence you received with hospital employees so to made them aware of important issues? I hope he is faster than the President in shedding more light on the affairs of UIC.

Anonymous said...

no one should expect a transparent internal review by UIC leadership given their corupt history and failure to provide previous oversight and discipline over their transplant program. After all, the previous leadership ignored facts disclosed to them by the former chief of transplant who had to eventually go to the State's Attorney office and feds who eventually won in federal court and fined UIC over fraudulent practice. All of that leadership was dismissed including the former President of the University, Vice Chancellor and Dean of the medical school as well as the governor who landed in prison; only Benedetti remains. UIC epitomizes chicago corruption and nepotism. So why should they act any differently today?

Anonymous said...

Everyone in academic surgery in The U.S. knows that [one of the surgeons] is a consultant, advisor for Intuitive. Speaking about conflict of interest and transparency, he has failed to disclose in any article that he has published on robotic surgery his conflict of interest that exists with Intuitive Surgical. This is a violation of the code of conduct with almost all peer-reviewed medical journals. Editors of the journals in which he has published should take heed of this and call him out as should University officials.

Note: I have removed the name included in this comment. I include the comment in the hope that the University's investigation will include an assessment of whether these assertions are valid or not; but it did not seem right to me to include the person's name without receiving documentation of the assertions. Paul

Paul Levy said...

TO; Anon from comment posted last night. I don't feel comfortable permitting your comment to be posted in that your characterization amounts to an ad hominem attack.

Anonymous said...

Paul, you are removing too many notes. The people who have written these comments are just pointing out corruption at the University of Illinois that goes well behind your outrage for the photo published a few weeks ago in the New York Times. Issues of fraud in credentialing and patient's safety have been brought up; it is up to the University of Illinois to decide if these allegations are true. You are actually protecting the same people you thought initially should be fired.

Paul Levy said...

I don't print ad hominem attacks. I also don't print accusations that are not supported by public documentation.

Fix both of those problems, and I'll print things.

Anonymous said...

Please go to PubMed and look under Giulianotti PC. He has recently published 4 manuscripts in the World Journal of Surgery that are just an advertisement for the DaVinci robot and Intuitive. There is no disclosure that both the Department of Surgery at UIC and him receive money from Intuitive. The symposium on Robotic Surgery is based on 10 manuscripts and 4 are from UIC. There is no disclosure whatsoever of the relationship between Intuitive and UIC. The fact also underlines the naiveté of the Editorial Board of the World Journal of Surgery.

Anonymous said...

This is an observation, not a complaint.

Intuitive now markets robotic surgery as "da Vinci Surgery procedures" and "da Vinci cases" from an email I just received. The word "robotic" is nowhere mentioned in their website as well.

This is a fascinating marketing tactic. Paul touched on this point: they may be trying to revamp their marketing to overcome grim financial outlooks.