In a recent news article, Gregory Demske, assistant inspector general for the U.S. Department of Health and Human Services, reported that the four largest manufacturers of hip replacements – all of which are facing legal action – paid “physician consultants” $800 million between 2002 and 2006. As defects in these designs became apparent and evidence surfaced to indicate that these companies were aware of the problems, these companies came under increasing scrutiny by the U.S. Department of Justice (DoJ).
Well, as a recent political candidate said during last year's campaign, “corporations are people, my friend.” Nonetheless, they still get to do things that ordinary, natural humans like you and I don't get to do – like making special deals with prosecutors and investigators. The “Big Three” - Stryker, Zimmer, Du Puy, and Biomet cut such a deal with the DoJ back in 2007: they would “reveal detailed information” about those consulting arrangements, provided the DoJ would drop its investigation into their practice of offering “kickbacks” to physicians in order to get them to use their products.
This in itself is not news; the media has been reporting on this for some time, now. However, a little-known 2008 survey of physicians – over 60% of whom were orthopedic surgeons and the majority of whom had been in practice for ten or more years – revealed some interesting facts. For example, over half of those doctors surveyed reported that they were aware of the deal between hip device manufacturers and the DoJ – but only one respondent said that these companies should be investigated.
Over 80% of the doctors surveyed reported using products manufactured by one of the companies in question – and nearly 95% said that publicity about these companies had no influence on their decision whether or not to use those products on their patients. Most, however – 78% – believed that the terms of consulting agreements, specifically in terms of pay and other compensation, should be made public.
Interestingly, over 90% of the doctors who responded to the survey said their patients had not even asked about the controversy at the time.
Approximately the same number of doctors said it was “appropriate for physicians to receive compensation for legitimate consultation work” done on behalf of companies providing the devices they use. However, many respondents added comments such as “much has been blatant bribery” and that the “numbers have been obscene.” One respondent said “a lot of physicians have been paid essentially just to use and keep using the products...without performing any legitimate consultation work,” while another said he had seen agreements made with “doctors of no significant academic credentials,” adding that they had received “astronomical payment, particularly when the product was successfully commertialized” [sic].
Surprisingly, over 97% of physicians who had been compensated for “consulting services” by a particular manufacturer said they had not been asked to used that company's products exclusively.
Still, when one is wined and dined and paid generously for one's expertise by a Fortune 500 corporation, is one going to just say no?
There is another insidious aspect to all of this.
In 2012 alone, the typical medical school graduate was burdened with an average student loan debt of $162,000 – meaning monthly payments of between $1,500 and $2,100 a month. At the same time, doctors' salaries continue to decrease as costs of maintaining a practice continue to rise. Several years ago, one medical writer blithely commented that “...future doctors will need expertise in medicine, business, accounting, and debt management in order to be successful and survive” - as if a total commitment to care and healing of patients and constantly keeping one's medical skills and knowledge up to date wasn't enough.
Everything has to be a business, it seems – even healing the sick and injured.
Could this be one reason that growing numbers of skilled surgeons and primary care doctors in the U.S. are from foreign countries – where qualified students can get schooling at little or no cost, or in exchange for a couple of years of national service, as opposed to a lifetime of debt bondage inflicted on American students?
It is yet one more symptom of the disease ravaging America – a society in which everything must have a price tag and make a profit for some corporation or financial institution – and how this ultimately affects everything, including health care and treatment options.