Sunday, March 30, 2014

How is it different?

Rosemary Gibson--author of The Treatment Trap--offered a trenchant comment on a ProPublica story by Charles Ornstein about how the University of Illinois violated its own policies by endorsing the product of a medical device company:

Okay, so in Europe, when device maker J&J paid doctors who are government employees to use J&J products, the DOJ and SEC called it bribery and a violation of the Foreign Corrupt Practices Act. J&J paid $70 million in fines and the SEC expressed concern about the public health of people in European countries. Why not here?

I looked into the case cited by Rosemary.  Here's the summary of the charge and the disposition. An excerpt:

The SEC alleges that since at least 1998, subsidiaries of the New Brunswick, N.J.-based pharmaceutical, consumer product, and medical device company paid bribes to public doctors in Greece who selected J&J surgical implants, public doctors and hospital administrators in Poland who awarded contracts to J&J, and public doctors in Romania to prescribe J&J pharmaceutical products.

Cheryl J. Scarboro, Chief of the SEC Enforcement Division’s Foreign Corrupt Practices Act Unit, added, “Bribes to public doctors can have a detrimental effect on the public health care systems that potentially pay more for products procured through greed and corruption.”

Ok, the case differed a bit from the US environment:

J&J subsidiaries, employees and agents used slush funds, sham civil contracts with doctors, and off-shore companies in the Isle of Man to carry out the bribery.

But the question Rosemary correctly asks is whether the J&J payments are equivalent to payments by other companies to public doctors and institutions in the United States.  The University of Illinois doctors who have been receiving financial support from Intuitive Surgical, Inc. are public employees.  Do we have any doubt that such a financial relationship influences the treatment patterns of those doctors?  Do we have any doubt that it has influenced equipment purchase decisions by this public entity (over $4.5 million in FY 2012, FY 2013, and half of FY 2014)?  Do we have any doubt that there is an incomplete disclosure to patients of the relative risks of robotic surgery compared to manual laparoscopic and open surgery at UIC? Shouldn't we make the logical leap that there is a "detrimental effect on the public health care system" when it comes to at least some of the Institute of Medicine's six domains of quality--safe, effective, patient-centered, timely, efficient and equitable?

I get the feeling that the folks at the University view this episode as over, a slightly embarrassing stain on the institution.  If so, I fear they underestimate the national degree of interest in this topic.  When the first "Sunshine Act" reports are made public in the coming months, we will see every form of payment made by Intuitive Surgical to the faculty of the University.  And to the faculty of every other public institution.

In the meantime, I am issuing a request to my readers:  If you know of faculty members of public institutions who have received payments from this company, would you please submit a comment with their names and, if possible, a publicly available site where I can confirm the matter?  I will not publish the comments, but I will use them for further research by me and also forward them to interested reporters in those jurisdictions.


Anonymous said...

USA patients thank you!!

Paul Levy said...

Thanks to the two anonymous commenters who have submitted information about two California examples.

Anonymous said...

article you might want to read in the Orange County Register about the influence of the company