Sunday, June 29, 2014

When disclosure doesn't disclose anything

A short while ago, I displayed a video from Bloomberg TV in which Dr. Michael Stifelman from NYU's Langone Robotic Surgery Center makes a number of assertions about the virtues of surgery conducted with the daVinci robot.  By all accounts, Dr. Stifelman is an excellent surgeon, but his comments were so in tune with those emitted by Intuitive Surgical, the maker of the robot, that my curiosity was piqued.  Could it be that he, like other doctors who have hawked this technology, has received financial support from the company?

I didn't want to make any assumptions on such a matter.  Fortunately, NYU has a requirement for annual disclosure by members of the faculty about industry relations and compensation.  So, I wrote to the institution and asked for copies of Dr. Stifleman's forms.  The two-part response:

1 -- All disclosures from our medical staff are confidential, so we’re unable to provide the information you request.

Sure enough, the rules say, "All disclosures will be kept confidential and disclosed only on a need-to-know basis." I replied:

"As a matter of public confidence, it is hard to understand why disclosures would be confidential.  If you were a patient, wouldn't you want to have the right to know if your MD was receiving payments from a pharma company or equipment manufacturer?"

2 -- We have policies in place concerning the endorsement of medical devices and the use of the institution's name in support of private companies and we are reviewing the matter you have brought to our attention.

I replied:

"Would you please provide the links to these policies so I can read them.  Also, will you please send me the result of the review you are conducting?  When might that be completed, and who is conducting it?"

To date, there has been no further response on these matters.   So I went looking.  I didn't have far to go.  Check out this video from 2012.  Here's a screen print:

In case you didn't get the message from the caption, here's a closeup of a "product placement" within the video:

Note that this video has a copyright by Intuitive Surgical, not NYU.  When a distinguished doctor allows his name and, indeed, his surgical acumen, to be used in support of a company-sponsored video, isn't that an implicit endorsement of a medical device?  Given Dr. Stifelman's very public position as head of the program at NYU, doesn't this amount to use of the institution's name in support of a private company?  Check out this video from the school and, again, see the very intentional conjoining of the NYU name and reputation with that of this equipment vendor.

Perhaps these examples, plus the Bloomberg TV piece, will help in "reviewing the matter you have brought to our attention."

Let's get back to disclosures, though.  Dr. Stifelman makes no attempt to keep confidential his testimonials from patients.

I in no way mean to take anything away from the feelings of grateful patients, and I am pleased they had excellent experiences, but it seems to me to be unseemly to use the observations and comments of people like this in public support of the doctor's practice when other matters--like potential financial support from medical equipment companies--remain behind a veil of secrecy.


Brad F said...

You need to update your readers re: the outcome at Univ of Illinois.

Have the parties reached a satisfactory denouement?


Paul Levy said...

Outcome? As far as they are concerned, the case is closed.

nonlocal MD said...

Well, this looks like a carbon copy of the situation at Illinois. Intuitive provides the bucks and the videos and the providers willingly allow themselves to be subverted to the advertising cause.

I really think the American College of Surgeons needs to get involved here and deem this to be unethical behavior for their members, who clearly are unable to recognize it as such with dollar signs waving in front of their eyes. Perhaps they should be contacted.

Paul Levy said...

Good thought, but as I recall one of the protagonists at UIC actually presented the virtues of this form of surgery in an all-day demonstration at the ACS annual meeting.

nonlocal MD said...

Well, but it's not the virtues of the surgery that are in question (in this post at least), it's the unethical marketing of it that is objectionable. Unless he had the Intuitive rep beside him at the podium.

Doesn't harm to just write a letter with these two excellent examples.

Barry Carol said...

It’s hard for a non-medical person like me to understand why there is such a culture of secrecy, opacity and confidentiality in medicine, especially at hospitals. While I can certainly understand the need to protect patients’ privacy, I don’t get non-disclosure of outcomes like infection rates, financial payments to doctors from drug and device manufacturers and, of course, contract reimbursement rates for care provided to patients. I don’t look to regulators or legislators to be of any help here because they are likely to be more responsive to industry lobbyists than the public interest.

Anonymous said...

Not only do I agree with the comment above, but I have asked questions regarding $$ and the like that were paid to a surgeon and in the business he sells. He is not a big name, hasn't done any research in the past few years and I'm wondering what qualified him to be on a "expert" speaker panel. So far, same as you when it comes to openness: hide everything they can. Its like prying open Fort Knox is easier. Yet we're supposed to just "trust them"? They don't trust us.

nonlocal MD said...

Barry, I think a huge amount of it is driven by fear of malpractice and misuse or misunderstanding of the data. Doctors feel like just the numbers don't tell the story fairly; there is always a reason why they had a bad outcome or whatever.

There is also increasing paranoia about Big Brother government coming down on them, partly driven by the Medicare RAC audits, but partly because a lot of doctors are republicans. ((:

I think the age of transparency is upon medicine and the younger generation of docs will adjust fairly quickly; not so much with the current leaders.

Lakshman said...

I wonder if patients who need these procedures at these centers really have an informed choice about whether they'll be getting the procedure via robot, lap, or open?