Saturday, March 29, 2014

They found a replacement!

My post of March 20 made note of a Seattle doctor who permitted her name and reputation--and that of her hospital--to be used in support of a medical equipment company.  Well, I'm guessing that--for whatever reason--either she or her employer told the company to stop doing that.

Luckily for the sake of American commerce, the company was quickly able to find a replacement.  Now the company's website has the following testimonial:

As in the case of the previous doctor, I have no reason to assume that Dr. Deckers is anything but a competent and caring doctor, but this kind of endorsement raises all kinds of questions.  Has she received financial support from this company, and, if so, has that been disclosed under the hospital's conflict of interest rules?

This company seems to have no trouble finding doctors to endorse its product.  Back in 2011, one of its press releases said:

“The TRUCLEAR System has quickly become the standard of care that women deserve,” commented Robert M. Biter, M.D., founder, Seaside Women’s Health, San Diego, Calif.  “It is a safe and effective way to diagnose and treat causes of abnormal uterine bleeding and risk of pregnancy loss.  TRUCLEAR has truly revolutionized my practice.”

Another from that year noted:

“I am thrilled that Smith & Nephew is introducing the new TRUCLEAR SIM Morcellation Simulator which will enable medical students, residents and practicing physicians to perform virtual hysteroscopic morcellation polypectomies and myomectomies,” said Larry Glazerman, MD, associate professor of obstetrics and gynecology and director of minimally invasive gynecologic surgery at University of South Florida Health. “Since patient outcomes are the most important part of any procedure, it is an incredible opportunity for gynecologists to perfect their technique prior to ever touching a patient.”

And in 2012, we learn:

“The TRUCLEAR 5.0 System combines safety, precision, and ease in the treatment of endometrial polyps and small uterine fibroids,” explains Dr. Charles Miller, Past President of the American Association of Gynecologic Laparoscopists (AAGL) and President, the International Society for Gynecologic Endoscopy (ISGE) in Naperville, Ill. “With this less invasive technology, I am looking forward to using TRUCLEAR right in my office – this is especially ideal for my fertility patients whom I prefer not to dilate.”

Also, in that year:

“With the TRUCLEAR System, I have the confidence to safely and effectively resect submucosal fibroids and endometrial polyps under constant visualization,” says David A. Stone, M.D., FACOG, who practices in metropolitan Detroit. “While using the TRUCLEAR ULTRA, I was able to remove a 2.5 centimeter diameter submucosal fibroid in a matter of a few minutes. Using this system can help preserve a woman's future fertility by minimizing damage to the uterus.”

What is it about these doctors that causes them to publicly endorse the product of a medical device company? Are they so moved by its efficacy that they feel highly motivated to spread the word? Or is there some relationship between them and the company that provides the impetus for such statements?

Why aren't health care journalists on top of every single such case of possible conflict of interest in their community?


Al Lewis said...

I think I can answer that question. If healthcare journalists pursued every case of conflict of interest, every blatantly fabricated outcome, every pattern of unnecessary procedures, and every reimbursement game, their profession would gradually become extinct becasue they wouldn't have time to reproduce.

JD said...

To at least partially answer some of this query, the Physician Payments Sunshine Act requires public reporting of industry payments to doctors.

jhb said...

Moving forward thiis problem is only going to become worse given the increased percent of pharmaceutical industry funded studies with decreased NIH research funding . The conflicts of interest could and probably will only get worse and the public will continue to be deceived.

Pat said...

Kudos Paul for being one of those journalists (yes, bloggers are now considered media)) that is reporting on the many conflicts of interest that are infecting our industry (deans on pharma boards, healthy system DaVinci ads that a copyrighted by DaVinci) etc. etc. etc.

Anonymous said...

In my experience many doctors are truly excited by some product improvement and want to tell all their colleagues. The rest is just administrative blather in their minds. It reflects seriously poor management in many organizations that they have not considered or established realistic policies on conflicts.

Nor should conflicts be limited to profit making sources. Anyone who has dealt with aerospace, environmental, or medical funding knows the desires of their funding sources and wants those grants to continue. These conflicts are just as big a source of bias.

Finally, there are important social biases. It's extremely hard to get papers published that say "We tried X, but it didn't work." Negative results don't get published. There are regulations that attempt to mandate publication of negative results in drug trials, but these have not yet made much difference. This isn't a financial conflict of interest. It's a social bias to prefer publication of successes.

It will be difficult for the journalists to handle this because it is a complex issue with lots of subtleties. Those make difficult stories.

e-Patient Dave said...

Morcellation?? Google News search it for recent developments - is this what the Globe says some hospitals (including MGH and BW) have just stopped doing, because it turns out it can accidentally spread an undiscovered cancer?

In any case my view is that, just as on TV, paid endorsers have to be disclosed IN THE AD. Long ago I remember hearing "Former NFL Quarterback Roger Stauback is compensated for his participation in this program."

Anonymous said...

Probably because another light shined on the problem health care industry is something that the moneyed leaders don't want.

Anonymous said...

Good for you Dave; I was just going to make that same comment. Yes, it is the same procedure (for fibroids, that is) as the one that has been in the news lately. You don't see that caveat in the ads, do you.

But I would go further than you. M.D's, should never, repeat NEVER, appear in an ad or publicly endorse a specific company's product. Ever. Very simple.

nonlocal MD

Anonymous said...

Your comments regarding endorsements are very reasonable. In an air of true transparency would you consider noting whether your have been compensated to participate in any of the conferences or meetings that you discuss on this blog (honorarium,airfare, lodging etc). Certainly if any participants have paid to attend this would seem extremely reasonable.

Storkdoc said...

This is not the same morcellator that is seen in the Globe. This is used inside the uterus to remove subserosal and intercavitary myomas. The uterus remains in place and any spillage is expelled from the uterus into the vagina. This is not a total laparoscopic hysterectomy morcellator that may seed uterine sarcoma tissue around the abdominal cavity.

This is a hysterscopic morcellator not a laparoscopic one

Paul Levy said...

I am not advocating for a product, so I wonder why you ask.

Anonymous said...

My question is not strictly limited to the post at hand.

With regard to your statement/question "I'm not advocating for a product..." in general, it's not clear to me that the situation is any different for a product or service. If someone provides a online positive review for a health care related conference that others pay to attend, and the reviewer has received any type of financial compensation from the conference/meeting, what duty exists to disclose that compensation. From some perspectives, this review could be considered a paid endorsement.

I'm sure people will have different takes and value systems surrounding this question. Curious about yours and others.

Paul Levy said...

I'm trying my best to see your point and the connection to the issue at hand. I've been writing about doctors who allow their names and thereby their reputation and that of their home institution to be used in support of a for-profit business.

You are suggesting that a conference is a product and that by saying something positive about the conference on a blog, a speaker is in the same category as a doctor who is hawking a medical product.

Does it matter to you if the conference is that of a for-profit conference company or a non-profit association? I'm guessing that your answer is "no," but maybe you can clarify that. (BTW, I don't believe I have ever written an article about what happened at a for-profit conference at which I was a speaker. Actually, as I think about it, I don't think I have ever chosen to be a speaker at a for-profit conference.)

In any event, I don't see how reporting on a blog about something that has happened at a conference is an endorsement of the conference. In my mind, it is simply reporting on something of interest that happened at that conference. Neither is it ever a condition or expectation of having spoken at a conference.

Let's see what others say.

e-Patient Dave said...

Thanks for the (kind, patient) explanation, Storkdoc. I'm glad I learned long ago to ask such things as a question instead of leaping into a rant.

e-Patient Dave said...

I think Anon 5:45 meant an era of transparency, not air.

Anyway, as you know I get paid all the time to give speeches at conferences, and sometimes they ask me to promote registration on the blog and sometimes I do it on my own. To me my reputation is EVERYTHING - without it nobody has any reason to hire me - and if people found that surprising, I suppose I wouldn't mind saying it, though my readers pretty much know that (as people know Paul).

But appearing in an *ad* is different. I've never done that, personally, and as many companies (even friends) will say, it's really hard to get me to endorse things, beyond a "woohoo / attaboy."

As I said earlier, I personally believe any endorsement in an ad MUST disclose when it's a paid endorsement. And I think it makes sense, in ads as on Twitter, to add "These words are my own, not my employer's."

Anonymous said...

Yes, era not air. Sorry for the typo.

Certainly not meant to be personally challenging, but rather to raise questions that I find generally interesting.

In an era where the lines between journalism and social media become blurred. (Pat: Kudos Paul for being one of those journalists (yes, bloggers are now considered media)) The lines between commentary and "ads" could become similarly blurred and then one wonders what the new rules/approaches disclosure are warranted. Certainly, as Dave hints at, full disclosure is never bad, but one wonders when it becomes a responsibility.

Don Sharpe said...

As e-patient Dave said, "just as on TV, paid endorsers have to be disclosed IN THE AD."
Makes sense.
Now, look at all the sycophant journalists ignoring what President Obama is doing to destroy America.
Imagine if every time POTUS went on TV they ran a caption, "he''s lying and living like a king on your tax dollars."
Now THAT would be truth in advertising.

Anonymous said...

Paul and Dave
Would be interested in your thoughts, not necessarily on the wider political and journalistic issues, but rather on the issue of guidance for disclosures by social media authors.

e-Patient Dave said...

Guidance for social media authors?? i just think it's the same as anywhere - I have no problem with anyone being paid to say or write something; it just shouldn't be secret.

i do think it's different when the person's paid to speak whatever they want (as i believe I am), vs when they're paid to advocate something. BUT that dives quickly into allegation and hair-splitting, so I say, just don't hide cash flow.

AND if you claim to be protecting the public's interest from ANY potential influence, it's best not to take money from anyone involved in that influence.

Now, someone may come up with a hair-split that makes me re-think that, but off the top of my head, that's what you get...

JeanneFromClearhealthcosts said...

Hey Storkdoc,

I'm in a learning mode too, as is Dave: the initial reports from the other kind of morcellation said it would never harm anybody ever. We sure this one won't either?

I am not a medical professional, but a journalist. Would love to see a citation of what you describe here in a journal with scientific evidence of a serious study, or something like that.

Thanks for your wisdom!

In response to Paul's larger question about health-care journalists covering conflict of interest: Yikes. We would do nothing else. As ProPublica's Dollars for Docs shows, conflicts are everywhere. Have you ever looked closely at 990's for nonprofits? I repeat: yikes.

Howard said...

In my opinion the physicians that publicly endorse a product are doing it because it is a subtle (really not so subtle) form of advertising. My guess is that they feel it enhances their stature in the community.

Another example of the degradation of my "dear and glorious profession."

Anonymous said...

Bottom line this....physicians are smart people. The salaries are chopped and the amount of labor is idiotic and inhumane. And the medical technology companies make a lot of money from what we use. Spifs and kickbacks in medicine are joined different than in any other industry. The wholesale trend is to devalue physicians. Real incomes have dropped 40 percent in a decade. So if a doctor gets paid to be in an ad, who cares. Don't you think the lawyer who referred me to my accountant got a very nice Christmas gift. And what about stock options for corporate management?

e-Patient Dave said...

Anon 7:30,

> The salaries are chopped and the amount of
> labor is idiotic and inhumane.

I don't think that's the point. I've often said in my speeches that I REALLY want the smart, hardworking people who saved my life to have a GOOD career, good rewards for their brains and study.

I think that's a separate issue from simply requiring that if they're paid to recommend something, that fact should be displayed along with the recommendation.

e-Patient Dave said...

AND, just in the nick of time, Consumer Reports to the rescue: from May issue's "Selling It" page, this marvelous image. (I wish I could embed it here!)

"Pitchman Approved!"

CR's caption:

Ya think?
If the paid pitchman doesn't approve the product, who will?

I love i when my mailbox comes to the rescue.