Thursday, November 01, 2007

Orthopedic Device Makers Reveal "Consulting" Payments to Doctors

We recently posted about deferred prosecution agreements a US Attorney made with four makers of orthopedic devices (Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Zimmer Holdings, and Smith & Nephew), and an agreement allowing federal supervision of Stryker Orthopedics (a unit of Stryker Inc). The companies were charged with violating anti-kickback laws by paying orthopedic surgeons as "consultants" to use their products.

As reported by the Dow Jones news service, as part of these agreements, the companies have all posted on their web-sites lists of physicians and physicians groups receiving such "consulting" payments this year. Here are the lists: Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer.

Although we have frequently talked about the pervasiveness of conflicts of interest in health care, rarely are the details of such conflicts reported. Journals sometimes require authors of articles and continuing medical education (CME) courses require speakers to divulge what commercial health care organizations have paid them, and the general nature of these payments, e.g. consulting, service on advisory panels, service on speakers' bureaus, etc. However very rarely are the amounts paid, or the nature of services rendered detailed.

These web-sites at least show to whom how much was paid in 2007 by these manufacturers of orthopedic devices.

Per the Dow Jones report, there were some striking revelations:

Zimmer Holdings Inc. (ZMH), the largest pure-play maker of replacement hips and knees, reported 21 instances of payments topping $1 million, more than double the number at any other company.

Zimmer, of Warsaw, Ind., issued 14 pages of itemized payments to consultants. The biggest payment, at $8.67 million, went to Massachusetts General Hospital Corp.

Disclosures of payments were also made by rivals Stryker Corp. (SYK), Johnson & Johnson (JNJ) unit DePuy, Smith & Nephew PLC (SNN) and privately held Biomet.

The biggest consulting payment from J&J's Warsaw-based DePuy, which was listed in a range of $6.725 million to $6.75 million, went to Thomas S. Thornhill, who chairs the department of orthopedic surgery at Brigham and Women's hospital in Boston.

Stryker, of Kalamazoo, Mich., made its biggest payment so far this year to Anthony K. Hedley, a surgeon and president of the Institute for Bone and Joint Disorders in Phoenix, at $3.025 million to $3.05 million.

Biomet, another Warsaw-based company, topped out with a $2.4 million to $2.425 million payment to Alabama Medical Consultants Inc. U.K.-based Smith & Nephew's biggest consulting tab this year is with Ramon Gustilo, an orthopedic surgeon and co-founder of the Midwest Orthopaedic Research Foundation in Minneapolis, at $3.125 million to $3.15 million.

So there were lots of payments to these "consultants." Some made eye-popping amounts of money for "consulting." What any of these physicians or medical groups actually did for this money is unclear. How these payments could be justified by the work these physicians did, and how an argument could be made that they did not influence these physicians' judgments and decisions is beyond me.

Remember, a physician's first responsibility should be to take the best possible care of each of his or her patients. An academic physician should also do his or her best to seek and/or disseminate the truth.

It might be difficult for a physician to make dispassionate decisions about orthopedic devices when one or more of the companies which make such devices is paying the physician thousands, hundreds of thousands, or millions a year. It may be similarly difficult to do impartial research or to do unbiased teaching when receiving such payments.

As noted many times (e.g., here), there has been considerable public concern about relatively small gifts, like pens, coffee-mugs, and pizzas, given by pharmaceutical, biotechnology, and device companies to physicians. If the effect that a coffee-mug might have on physicians' judgments and decisions is of concern, what about a million dollar plus consulting payment?

It is high time for all the payments made for "consulting," advisory boards, speakers' bureaus, etc, etc, etc by commercial health care corporations to physicians and other who make decisions about health care and health policy to be divulged. I suspect that if the public had any idea how many payments of what size were being given out, they wouldn't further stand for such nonsense.

A hat tip to, and see also discussion on the PharmaLot blog and the WSJ Health Blog.

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