Sunday, January 13, 2019

Memorial Sloan Kettering in Bed With Industry


Is there corruption in the medical profession?  Recall Captain Renault’s iconic rejoinder to Rick in Casablanca.

“I’m shocked, shocked to find there is gambling going on in here!”



In any enterprise with billions of dollars at stake, and when different players have competing interests which may not coincide with the public’s interests, there will be skullduggery.  How do you think our Defense Department and its relationships with vendors would look if we were able to shine a bright light on all its faces?  Do you think it’s possible that a weapons manufacturer might argue, through lobbyists and salesmen, that its weapons are essential to national security and superior to those of a competitor?   How about when a congressman argues for the continued purchase of military equipment manufactured in his district that military experts state is no longer needed?  And, there’s the quintessential and craven corruption of legislators refusing to close military bases in their districts that the military want to close down.

And, so it is with the Medical Industrial Complex where the arena is filled with jousting pharmaceutical execs, hospital administrators, insurance companies, the government, medical device companies, physicians, pharmacy benefit managers, politicians and the public – all competing to protect their interests.  Does this system seem optimal to achieve a greater good for society?

Recently, the Chief Medical Officer of the Memorial Sloan Kettering Cancer Center in New York City ‘resigned’ in the wake of disclosures that he failed to disclose financial relationships with outside health care companies.  In other words, it was a failure to disclose that ousted him, not the conflict.
 
Here’s my riposte to this.  The obvious weakness in our current disclosure policy is that the emphasis is on the disclosure and not the conflict.  Following nearly every medical article that I read, appears a long list of disclosures, often in small font, listing the various business relationships that the authors have with various companies.  Apparently, in the authors’ and the editors’ minds, the disclosures have provided them with adequate ethical insulation.  They argue that readers can weigh the disclosures when they assess the authors’ credibility. For example, if an article is extolling a new diagnostic test, readers may be informed that the author is a paid speaker for the company that manufacturers the test.  The actual conflict, however, remains. 

Over the past 10 years or so, practicing physicians and scientists have been so deluged with disclosures in our journals and at our professional meetings that we have become numb to them.  (How carefully do we listen to the safety presentation given by flight attendants prior to take off?)  The ongoing tsunami of medical disclosures have vitiated their potency, and as I stated above, do not address the actual conflicts. 

The connections between medical science and medical industry can create great benefits for humanity.  I accept and encourage this.  And, I’m all for full disclosure.   But, personal and institutional integrity must be paramount.  Oftentimes, the conflict itself should be disqualifying and no simple disclosure should be permitted to cure it.

Addendum:  The Chief Medical Officer who 'resigned' was immediately hired by... yes, you guessed it, a pharmaceutical company!  And, Sloan Kettering (SK) now prohibits its leaders from serving on corporate boards.   Can we assume this to be an admission that SK now recognizes that such business relationships are improper or did they simply feel the optics were uncomfortable.

Comments, confessions, and disclosures welcome. 


Sunday, January 6, 2019

Medical Device Sales Rep Kills the Sale

A few weeks before writing this, two device salesmen came unannounced to our small private gastroenterology practice.  They were hawking a product that could quickly and non-invasively determine how much scar tissue had formed in a patient’s liver, a useful tool for assessing patients with hepatitis and many other liver conditions. 

We are physicians, not entrepreneurs.  We do not regard the colonoscope as a capitalist tool.  Yet, these two salesmen were barraging us with facts and figures on how much money we could make off their product.  They knew the insurance reimbursement rates and could quickly calculate our practice’s return on investment depending upon our projected volume.  They recognized that the cost of their device would be beyond our reach and offered to sell us a ‘refurbished’ product at a huge discount.

Liver Sales Reps Ignored the Liver!

For a host of reasons, we were not interested in acquiring the device, which we could not afford.
Here’s what was so striking.  Not once did either of them mention, even by accident, that their product was a device that might help a human being.   These guys were so clumsy and so transparent that they weren’t even adept enough to feign an interest in contributing to the health of liver patients.  Of course, we would have seen right through this pretense anyway, but at least they would have gone through the motions with the hope that we might not have recognized their charade.

Afterwards, our office manager was deluged with e-mails beseeching us to reconsider our refusal, offering ‘new and improved’ calculations that promised us profitability.  And, borrowing a technique from late night infomercials, they now offered an even steeper discount on a newly discovered refurbished product that was a deal they advised that we should not pass on.

We have many sales folks who come to see us.  Of course, we understand that they are selling products.  But a true sales professional understands his customer, and these guys massively misfired.  We are physicians, not hedge fund managers who regard income generation as our primary objective.  How should salesmen sell to doctors?  When device or pharmaceutical representatives come to see us, they are best poised to sell us on how their wares can help our patients improve their lives.  The product that can sell itself, sells best.  

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