Thursday, February 20, 2014

The Chicago Tribune reports on the University of Illinois

Karisa King and Jodi Cohen at the Chicago Tribune have published an excellent story about how some doctors and admininstrators decided to use the name and reputation of the University of Illinois in support of a medical device company.  With access to internal emails, it becomes clear that an explicit decision was made to do so by very high-ranking officials:

Benedetti, the head of surgery, sought advice and permission from Jerry Bauman, interim vice president for health affairs, and Dr. Dimitri Azar, dean of the College of Medicine, according to an Oct. 23 email obtained under the Freedom of Information Act.

"On one side it would be a lot of free publicity for our program, on the other side we could be criticized to be included in an industry generated campaign," Benedetti wrote. The two responded separately that the visibility would be good for the program.

Others apparently had doubts:

After receiving a Jan. 10 email from Benedetti, in which he forwarded the group picture and congratulated the team for the "important recognition," Dr. Bernard Pygon forwarded the email to a colleague and wrote: "Interesting that he calls this recognition — it's an ad for a for profit company."

On the financial front:

The Tribune also found that some doctors pictured in the ad did not initially disclose their financial ties to the company that makes the robot, Intuitive Surgical Inc., as required by the university's policies on conflicts of interest.

But it appears that the lessons have yet to be learned.  Without regard to the facts that might arise from an ongoing investigation of these matters, and without regard to the lack of scientific evidence in support of a statement about medical outcomes, the University does not hesitate in drawing premature conclusions:

Hardy, the university spokesman, said participating in the ad was "a good faith effort" to promote expertise that has "demonstrably beneficial outcomes for patients," but the execution was perhaps not well thought-out.

"In hindsight, the effort could have been better, or perhaps should not have been undertaken at all," Hardy said. "Although the ad may not have violated policy, a decision was made immediately to pull it and to conduct a review of the circumstances involved with the aim of correcting any mistakes that might have occurred."


Anonymous said...

Pygon cannot stand up and smile in front of the camera thinking what he later wrote. Clearly he should resign. Remember he is the CMO, an institutional higher-up

Anonymous said...

A few comments:

It seems evident that the investigation at UI was launched as a result of Tribune probing hard. Thanks to ,.

Always follow the money:
1) One surgeon comes from Italy without residency in US and not being Board Certified here. He is not a world expert. He goes out and teaches?
2) Another surgeon is always seen at professional meetings demonstrating the use of the robot. Sessions are usually multi-days. How much does he get for that??? He forgot...
3) The Hospital invested 16M of our money to do 800 cases a year? What is profitability??? What are those cases? What are those outcomes? How can you justify those numbers in this era?

One surgeon said he "misunderstood", Hardy said "a good faith mistake", Pygon, the chief medical officer, said it was a bad idea but he did it anyway.

There you have it, the UI investigation. They will get a slap on their hand and things will flow as usual.

This is crazier than I thought...

Trainee Tom said...

I think this whole case smells a little bit like a calculated money grab and a poor use of academia-industry relationships.

However, I think from a medicine perspective, it raises the critical question that we need more evidence. We need more data to see whether robotic surgery actually works or not. The premise has and still remains that robotics allow for less tissue damage either from less extensive resections or from less torque on tissues to get access to your target, therefore, recovery times are shorter, and thereby decreasing overall costs for the entirety of the stay. There are no studies on complications and including those in the costs. I think it seems plausible that robotic surgery could indeed be cost-effective, in certain populations. Let's first solve the issue of whether we should be doing the surgery in the first place before we discuss how that gets broadcast.

Anonymous said...

I agree with your comments. I noted that in addition to the ethical issues of the relationship between the Department of Surgery at UIC and the Industry, you raised the issue of licensing in Illinois of surgeons who did not train in the US. It seems to me that the American College of Surgeons should start its own investigation.

Anonymous said...

I am a General Surgeon in Illinois. I was born and raised in South America where I completed Medical School and a Residency in General Surgery. I was 28 years old when I moved to the United States in search for a better education. I had to pass the required USLME exams and then I was able to find a postion in a five year General Surgery program in the East Coast. Eventually I passed the exam of the American Board of Surgery. I thought that this was the only way to practice surgery in the United States.

However, reading this article in the Chicago tribune and Mr. Levy's blog, I realized that some people are able to cut corners and cheat the law. I searched one surgeon. He came in 2008 and at that time he was unknown. He had major ties in Italy with the industry and specifically with Johnson and Johnson and Intuitive. How was he licensed in the United States? He is not registered in the American Board of Medical Specialties. Do his patients know? Do the insurance companies know?

I also searched another surgeon who made $16,000 coaching real surgeons in American Hospitals. He was brought by Dr. Benedetti to UIC as an international expert. At that time he had 6 publications only. He never completed a residency in the United States, he never passed the ABS exam. He is not registered in the American Board of Medical Specialties. How was he brought to UIC? How was he licensed in Illinois? How was he granted privileges at UIC? And how can he teach other surgeons in other hopsitals on the payroll of Intuitive?

Let me stress again that I am a Foreign Medical Graduate. But the FMGs at UIC are breaking all the rules and making fun of the AMA and the American College of Surgeons. Let me also remind you that the current President of the American College of Surgeons was born in Argentina where he completed medical school and general surgery. But when he came to the States he had to repeat a General Surgery Residency at the University of Chicago. Are Dr. Pellegrini and I stupid or just honest?

[Paul's note: I have removed the surgeons' names in this comment.]

Anonymous said...

Paul, I am glad you removed the names of the two surgeons. This is not a personal attach against them. They are just dishonest and they are enjoying complete lack of supervision and regulations at UIC. I understand however why so many surgeons are resentful: (1) The public tends to generalize. It is indeed unfortunate that because of few rotten apples, every surgeon will be scrutinize and will have to prove his/her honesty; (2) Surgeons in the States are proud of their training. It is hard, it is long, but it is the best in the world. Anybody from other countries is welcome to train in the States, if they can. It is immoral, however, to allow some to bypass our rules and come as "international experts". UIC and the state licensing board in Illinois should investigate their credentials and how a license to practice was granted. As suggested, the American College of Surgeons should also start its own investigations to protect their legitimate membership.

Anonymous said...

Why are they ALL Italian citizens? Doesn't the University of Illinois ever hire American robotic surgeons?

Anonymous said...

"As a large and complex organization that adheres to high standards, the U of I is compelled to tell its public this fact: the University is run by fallible human beings," the statement said. "It is operated by people trying their best. We regret when those efforts fall short."

Maybe those individuals’ best is not enough to function in their job of high responsibility. “We regret”? This response should imply that this genuine sense of regret should evoke a thorough investigation with a clear definition of accountability and probatory actions. Sorry, Mr. Hardy, “we regret” should not be enough at UIC, for UIC, and anywhere, as a matter of fact. It is disrespectful to those at UIC who work hard and really excel. Leaders should expect, inspire, and foster “excellence” not “people trying their best”. If these expectations were not met, then “knew it was a bad idea” would be the norm and will exemplify mere mediocrity.

“Intuitive selected Bianco to watch six operations at hospitals still at an early stage of using the device and paid him $2,650 in each instance with money provided by the hospital, documents show. Bianco received an additional $500 for observing a hernia operation.”

The reporter may be incorrect. One does not get paid an honorarium to literally “watch” or “observe”. One gets paid for “proctoring”, that is watching/observing another surgeon ensuring he/she makes no mistakes during the operation. Maybe someone else in the blog may want to pitch in about the implications of a quasi-expert (I wanted to say non-expert but I toned it down for fairness), non-trained, non-board-certified individual “proctoring” in this setting.

“The university agreed in 2011 to spend $2.8 million for two additional da Vinci systems and a service contract — one to use for surgery and the other to teach medical students, according to board minutes.”
Wait a second… They really spent $1.8M to train the students? Why is then the program on probation by the ACGME? Can you imagine what $1.8M could do for education if “well” spent?

Anonymous said...

Let me help with the issue described above. I have done a lot of proctoring in the past for laparoscopic cases (I have no experience with the DeVinci robot). I have been a proctor in my hospital and in other hospitals. It is a very demanding task. You are the expert in the operating room but you are not allowed to scrub. You slowly become the eye and the brain of the surgeon you are proctoring. In a fraction of a second a hole can be made in a viscus, a ureter can be transected. But I liked it very much and I took a day off from my practice every month to proctor. I enjoyed the extra income (which I declared in my income tax return) and I enjoyed sharing my experience with younger surgeons.
There are quite a few things I find "strange"as described in the blog of of February 20, 4:46 pm:
- How can a young, non board certified surgeon, self-declared expert from another country, function as a proctor in the United States?
- I am in private practice and I can take time off whenever I want. How can this surgeon who is paid by UIC (a state university) take time off and go somewhere else to proctor and being paid by a private company?
I hope that the University of Illinois at Chicago can shed some light, impose some discipline, and teach some ethical behavior.

Anonymous said...

As a former staff nurse at the U of I I am not surprised about these actions. Also not surprised about the arrogant attitude from the Italian contingent of surgeons. Also Dr. Pygon is not so innocent.Was waiting for something like this to happen one day, when you think so highly of yourself you will eventually fall.

Anonymous said...

To former UIC nurse:
"Neither good or evil ever remain hidden". ----- Rostam: Tales of Love & War from Persia's Book of Kings

Anonymous said...

We knew eventually one day this would happen!

The above-the-Board of Trustees Dept chair's reign should be over as a result. However, one of the Junior faculty will suffer instead.

Paul Levy said...

Note to Anon above. I removed a word from your comment.

Anonymous said...

To anon 9.06
Why does the junior attending have to pay when the Dean allowed the entire department and an insicure CMO to pose for the photo aware of all the consequences?
Nothing will happen to any of them and they know that.
However you said: Junior Surgeon. So I wonder: how can a Junior Surgeon become a US prof of surgery? How can another one can become professor with an endowed chair? They are "visiting", so why Ms Marisa King and Ms Cohen do not find out for how long will they be visiting for?

Anonymous said...

Allow me to disagree with this statement. Even though there is no question that Department Chair made an error in judgement allowing this ad paid by Intuitive to appear in the New York Times, I do not think that we should forget how much he has done for UIC and for transplant patients. He should not be considered part of the "Italian contingent", it would not be fair. He trained in the US and went up the academic ladder at UIC. I think that his major flaw has been to bring surgeons from abroad, with a different background, different ethical values and questionable training, without providing proper supervison, and allowing them to become an advertisement vehicle for a private company and being compensated for that. As stressed in another blog, these other surgeons are full time employes of UIC and should not be allowed to take time off as they were Intuitive employes.
Finally..............Rostam's quote is true, and beautiful. However, the problem in Illinois is that even when evil is discovered, it rarely gets punished. Let's wait and see the response of the University of Illinois at Chicago and how the Chair, the senior and the junior surgeons get disciplined.

Anonymous said...

Thank you for your comment. I agree with you, it would be too simple to just blame it on the Junior attending. But I do hope that UIC shows some good judgement. The article that appeared in the Chicago tribune was incredibly powerful and accurate. It has been read by millions of people, and I do not think that the leadership of UIC can ignore it. Please do not forget that even in Illinois corrupted people get punished, even governors.
On the other hand you raised a very important point. I was not aware of the title of "Visiting Professor" and how this allows foreign doctors to work in the US. The "Italian contingent" mentioned by the former UIC nurse comes from Grosseto, a small city in Tuscany with less than 100,000 inhabitans. Grosseto does not have a University and these surgeons were working in a public hospital. I wonder if Ms King and Ms Cohen would want to extend their investigation. These are more than just "ethical issues" about an ad in a newspaper, this is about the safety of our patients and the legality of the process.