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Nov

Standing up for ourselves: countering the anti-surgeon, anti-industry narrative

Posted: Nov-5-2010 10:22 AM ET  |  Add Comment  |  Comments (3)

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This blog kicks off a series about the current narrative emanating from policymakers, academia, and the media. This Narrative (its ubiquity earns it proper name status) focuses overwhelmingly on, to quote the Columbia Journalism Review, "unsavory practices in the medical profession."1

We have seen an explosion of stories casting doctors and medical device manufacturers in a negative light. Most focus on four key areas: (1) the supposedly corrosive effect of surgeon-industry collaboration; (2) device companies' purported lack of concern regarding the quality and clinical performance of their products; (3) the amount of money specialists make compared to primary care physicians, and (4) the supposed overutilization of certain surgical procedures.

Here's a sampling of recent material:

  • "There is too much surgery being done and industry is facilitating it...because they're creating the demand by sponsoring fellowships."-Charles Rosen, MD, quoted in The Atlantic.2
  • "While [doctors are] at it, better to avoid NASCAR-esque patches glued onto those white coats, too..."-Ford Vox, The Atlantic, referring to physicians who consult with medical device manufacturers.2
  • "Costs surge for medical devices, but benefits are opaque" –Headline, New York Times, November 5, 2009.3
  • "Medical devices that can kill: Defibrillators, stents, artificial hips-medical devices that should save lives can maim or even kill." –Reader's Digest, August 23, 2010.4
  • "Everyone is vulnerable...people have stumbled into disaster when they got a hip replacement, for instance..."-Shannon Brownlee and Jeanne Lenzer, Reader's Digest, August 23, 2010.4
  • "New hips gone awry expose U.S. kickbacks in doctors' conflicts."-Headline, Bloomberg News, June 11, 2010.5
  • "When heart devices fail, who should be blamed?"-Headline, New York Times, April 20, 2010.6
  • "Health system bears cost of implants with no warranties."-Headline, New York Times, April 2, 2010.7
  • "Either they do not have faith in their products, or they are just saying tough luck to patients...it borders on unethical business behavior."-Arthur Levin, quoted in New York Times, April 2, 2010.7
  • "So besides the woozy-making dollar amounts involved, and the widespread number of Lies and the Lying Liar-Surgeons Who Tell Them, what was the third shocker in this tiny news announcement?"-Doc Gurley, San Francisco Chronicle blogger, September 14, 2010.8
  • "We are over-medicalized. We sell sickness. We fearmonger. We disease-monger. We are actually again being sold on the weapons of mass destruction in our lives, but these are weapons of mass destruction inside us."-Gary Schwitzer, Minnesota magazine, April, 2009.9

The pervasive media drumbeat creates an unbalanced and often inaccurate picture of the medical device industry and the surgeons who rely on its products to deliver life-changing treatments.

Journalism or advocacy?

The journalism establishment seems to believe that it has an obligation to not only report on healthcare policy, but to shape it. Gary Schwitzer, a leading figure in healthcare journalism, quoted above, is publisher of HealthNewsReview.org, a self-proclaimed watchdog for accuracy in healthcare journalism, and a vocal proponent of journalistic activism.

In a 2009 interview, Schwitzer said "There is an agenda-setting role for health care journalism that is too often abdicated."9

Schwitzer, who has served on the board of the Association of Healthcare Journalism, has made clear his belief that healthcare journalism is under the spell of the pharmaceutical and medical device industries. He states: One thing we've noticed is how easy it is for journalists to become marketing arms of industry."10

He's clearly reading different newspapers than I am.

The "independent expert" list

Schwitzer is custodian of a list of "independent experts" who do not accept industry funding, and to whom journalists are encouraged to turn for pithy sound bites.10,11 The British Medical Journal originally published the list,12 compiled by Shannon Brownlee and Jeanne Lenzer, who wrote the article "Medical Devices That Can Kill" mentioned above. The current list11 includes well-known industry critics, including Schwitzer himself, as well as:

  • Adriane Fugh-Berman, MD, who stated: "Perhaps physician-investigators should create and uphold a standard where relationships with industry are regarded as unsavory rather than sought after."13
  • Carl Elliott, author of "White Coat, Black Hat," who stated in his book that "I do not claim to offer a balanced picture of contemporary American medicine. My interest is in how medicine has gone wrong, not in what there is to admire."14
  • Marcia Angell, who has written numerous anti-industry screeds, including "The Truth About Drug Companies: How They Deceive Us and What to Do About It."15
  • Charles Rosen, MD, who made the bewildering statement quoted above, blaming industry funding of fellowship education for supposed over-utilization of treatments.2

The lists' authors expose their own bias when they refer to doctors with industry ties as "on the take" and state that "the media are filled with happy talk about 'medical breakthroughs' that is based on information gathered from sources with ties to industry."12

By this standard, Sir John Charnley's statements about hip replacement should be dismissed as mere "happy talk"-he was, after all, "on the take."

It's not clear whether industry critics in the media and policymakers are working together to move a particular agenda forward. It goes without saying, however, that the media can shape public opinion, and that public opinion can influence policymakers. As Congressman Henry Waxman stated, "Policymakers' ability to bring about change often depends on whether and how the press reports the issue."16

The irony: insurance industry funding of our critics

Despite his protests that industry money is corrupting medicine, Schwitzer's own organization receives its funding indirectly from the insurance industry. All of its funding comes from the Foundation for Informed Medical Decision Making10, which receives "much of its funding" from Health Dialog, a commercial company whose mission is to "bring to practice the groundbreaking research of Dartmouth researcher Dr. Jack Wennberg."

Health Dialog's Chief Science and Products Officer, David Wennberg19 is Jack Wennberg's son and also part of the Dartmouth Atlas group, which believes that doctors, and specialists in particular, drive up healthcare costs through unwarranted use of medical procedures.20, 21

In 2007, Dartmouth researchers sold Health Dialog to Bupa, an international health insurance company, for $775 million.21, 22

Unlike the industry critics funded by Bupa, I do not assume that industry funding creates bias in the work of Schwitzer's group or the experts it promotes; the work should be evaluated on its merits.

And while Schwitzer's group has every right to voice its opinions about our practices, it seems disingenuous to not adhere to the standards it advocates.

It's time to stand up for ourselves

Medical device companies and their leaders recognize that our primary mission is to help healthcare professionals deliver high quality medical care to the patients that we jointly serve. Companies can only be successful in their markets if they are successful in that mission. This is one of the reasons that we love what we do.

Unfortunately, we are not blameless in having created this negative environment in which we operate. Medical device companies and surgeons have had our share of high-profile problems that have contributed to negative press coverage. We have seen instances of illegal and unethical behavior; these events are unacceptable and contribute to skepticism about our work.

Recognizing these problems, the medical device industry has worked diligently to set strict guidelines for ethical behavior. I am honored to chair AdvaMed's Board Committee on Ethics and Healthcare Compliance and Biomet has certified to the AdvaMed Code of Ethics on Interactions with Health Care Professionals.

Despite these ongoing efforts, industry finds itself continually hectored by a hostile media that engages in the very fear-mongering that Schwitzer himself decries.

The unrelenting and essentially unanswered attack on specialists and industry has gone on for far too long. In future blogs, we will tell the other side of the story, addressing the fallacies in each of the four major areas discussed above.

It is time for all of us who feel passionately about our contributions to patient care to work together; to create a counter-narrative to refute those who seek to demonize us and trivialize our contributions. The orthopedic community must insist that policymakers, academics and the media fairly report a balanced view of our efforts and the life-changing benefits we deliver.

References
  1. Lieberman T., "A Lauren to the Milwaukee Journal Sentinel," Columbia Journalism Review Campaign Desk, June 18, 2010, available at http://www.cjr.org/campaign_desk/a_laurel_to_the_milwaukee_jour.php
  2. Vox F., "The Medical-Industrial Complex," The Atlantic, June 29, 2010, available at http://www.theatlantic.com/technology/archive/2010/06/the-medical-industrial-complex/58888/
  3. Meier B., "Costs surge for medical devices, but benefits are opaque," New York Times, November 5, 2009, available at http://www.nytimes.com/2009/11/05/business/05device.html
  4. Brownlee S., Lenzer J., "Medical Devices That Can Kill," Reader's Digest, August 23, 2010, available at http://www.rd.com/living-healthy/medical-devices-that-can-kill/article184371.html
  5. Armstrong D., "New Hips Gone Awry Expose U.S. Kickbacks in Doctors' Conflicts," Bloomberg, June 11, 2010, available at http://www.bloomberg.com/news/2010-06-11/new-hips-gone-awry-expose-u-s-kickbacks-in-doctors-conflicts-of-interest.html
  6. Meier B., "When Heart Devices Fail, Who Should Be Blamed," New York Times, April 20, 2010, available at http://www.nytimes.com/2010/04/21/business/21device.html
  7. Meier B., "Health System Bears Cost of Implants With No Warranties," New York Times, April 2, 2010, available at http://www.nytimes.com/2010/04/03/business/03ortho.html
  8. Doc Gurley, "Million dollar lies and the surgeons who tell them," San Francisco Chronicle SFGate, September 14, 2010, available at http://www.sfgate.com/cgibin/blogs/gurley/detail?entry_id=72239
  9. Nettleton P.H., "Sick about Health Care," Minnesota, March-April, 2009, available at http://www.minnesotaalumni.org/s/1118/content.aspx?sid=1118&gid=1&pgid=1017
  10. Schwitzer G., "Changing the Drumbeat of typical Health reporting," Nieman Reports, Spring 2009, available at http://www.nieman.harvard.edu/reportsitem.aspx?id=100954
  11. "Independent Experts," HealthNewsReview.org, available at http://www.healthnewsreview.org/list-of-independent-experts.php
  12. Lenzer J., Brownlee S., "Is there an (unbiased) doctor in the house?" BMJ, July 26, 2008, available at http://www.bmj.com/content/337/7663/Observations.full.pdf
  13. Fugh-Berman AJ, "The Haunting of Medical Journals: How Ghostwriting Sold 'HRT,'" PLoS Medicine, September 7, 2010, available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000335
  14. Elliott C., "White Coat, Black Hat: Adventures on the Dark Side of Medicine," Beacon Press, September 14, 2010. See also Satel S., "Drugs and Money," The New Republic Online, available at http://www.tnr.com/book/review/drugs-and-money
  15. Angell M., "The Truth About the Drug Companies: How They Deceive us and What to Do About It," Random House Trade Paperbacks, August 9, 2005.
  16. Otten AL, "The Influence Of The Mass Media On Health Policy," Health Affairs, Winter, 1992, available at http://content.healthaffairs.org/cgi/reprint/11/4/111.pdf
  17. "Funding," InformedMedicialDecisions.org, available at http://www.informedmedicaldecisions.org/funding.html
  18. "Mission," Health Dialog, available at http://www.healthdialog.com/Utility/Company/Mission
  19. "Management Team," Health Dialog, available at http://www.healthdialog.com/Utility/Company/Management
  20. "Preference-Sensitive Care," Dartmouth Atlas Project, January 15, 2007, available at http://www.dartmouthatlas.org/downloads/reports/preference_sensitive.pdf
  21. Abelson R, Harris G, "Critics Question Study Cited in Health Debate," New York Times, June 2, 2010, available at http://www.nytimes.com/2010/06/03/business/03dartmouth.html?_r=1
  22. "Partnerships and Relationships," Health Dialog, available at http://www.healthdialog.com/Utility/Company/Partners
  23. "Reducing 'unwarranted variation' and improving care delivery," Bupa, available at http://www.bupa.com/healthcare/healthcare-affordability/unwarranted-variation

3 Comments to Standing up for ourselves: countering the anti-surgeon, anti-industry narrative


The opinions expressed in the comments section of this blog are solely those of the commenter.
Submitted: Nov-10-2010 8:02 AM ET by Gregory R Nelson

If we keep going down this slippery slope where quality care to the patient is no longer a priority, where then is the bottom? Does R&D spending dry up? Will reimbursement set such low limits that doctors are forced to dumb down to a "minimal care" and are forced to use poor products mostly made in China . Let's hope not...

Submitted: Nov-13-2010 9:56 AM ET by Joseph Marotta, MD

As an orthopedic surgeon, I share all of the frustrations that have come to be common place in our field. We have given up control of our image to the lawyers out for gain and media muckrakers trying to make a name for themselves. We need some good marketing media exposure to get our message out. Unfortunately most doctors are too busy helping people to spend time in press campaigns or political rallies.

Submitted: Jan-3-2011 9:01 AM ET by mongo46538

From a potential patients point of view versus that of an industry insider who would be inundated by the type of journalism we are talking about here, I can only say that these journalistic trends seem to follow some of the same trends we see in cable news and political pundit theater. Whereas controversy sells copy and if there is no distinguishable controversy to be had, let’s create some based upon supposition. In regards to Gary Schwitzer's comments, (The article of which I have not read) I can say it is tiresome to sit on the couch at the prescribed time and station my demographic is being marketed too, and listen to all the television commercials telling me how old and fat and sick I am and I should "talk to my Doctor" about this and that. Yes of course I can switch off the tube and go out for a walk, jog or bike ride, but after I'm done and exhausted, I rehydrate and come right back to the same barrage of pharmaceutical propaganda. The silver tongued disclaimers at the end of each of these commercials can almost be comical. Pharmaceutical companies seem to follow the software method of product rollout. After the minimum required amount of study, let's dump this out on the market and works the bugs out from there. However, from observation, it seems to me that medical device manufacturers, orthopedic in particular, have yet to descend to this level of embellishment. There have been some television spots by major orthopedic players but the overtures do not qualify as fear mongering and in my opinion are relatively benign. The difference I see between Pharma and Ortho can be paraphrased as, with Pharma "You may have a problem...", with Ortho it’s "You KNOW you have a problem...", and most likely you're in pain and can't walk. It's asinine to decry the amount of collaboration necessary in the orthopedic industry, financial or otherwise when you consider the nature and degree of biomechanical engineering required to bring a product to market that will not only function properly but "install" properly as well. There will always be potential for abuse in an industry where the ends and the means have to co-operate to achieve the desired effect, but it seems unfair to make overly sweeping generalizations about two industries at such opposite ends of the medical spectrum.

This post was written by a Biomet team member.


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