Posted On: February 25, 2014 by Patrick A. Malone

Hospital Promotion: Poor Judgment Looks Like Conflict of Interest

For all its techno-wonder, robotic technology is fraught with problems, including organ damage, that make it unsuitable for many surgical procedures. It also has a record of poorly trained surgeons, not to mention the under-reporting of adverse outcomes.

Then there’s conflict of interest, or what sure looks like it.

A story covered by ProPublica.org, the investigative news site, examined the role of a dozen members of the surgical team at the University of Illinois Hospital and Health Sciences System who were featured prominently in an advertisement for the da Vinci robot. The copy read, “We believe in da Vinci surgery because our patients benefit.”

Paul Levy, former chief executive of the prestigious Beth Israel Deaconess Medical Center in Boston, was among readers who had a problem with the ad. “While I have become accustomed to the many da Vinci ads,” he told ProPublica, “I was struck by the idea that a major university health system had apparently made a business judgment that it was worthwhile to advertise outside of its territory, in a national ad in the New York Times.

At the bottom of the ad for the robotic device, made by Intuitive Surgical Inc., was this notice: “Some surgeons who appear in this ad have received compensation from the company for providing educational services to other surgeons and patients.”

Ah.

When you are paid to promote a technology for which your patients also pay when they are subject to it, it looks as though cashing in is more important than ensuring that a procedure is the best possible treatment for the problem at hand. Is that what happened here?

Robotic surgery is a minimally invasive procedure in which the surgeon uses a computer to remotely control small instruments. The systems are expensive, and because they’re hot, new technology with marketing potential, surgical facilities that invest in them are highly motivated to use them, whether or not the robotic method is the best one for a given surgery.

As we’ve pointed out, in some cases such as hysterectomy and prostatectomy, they often aren’t.

For a long time medical professionals have been subsidized by pharmaceutical and medical device companies, and we’ve written about Dollars for Docs, a ProPublica database of who is getting paid by these commercial interests.

And although ads featuring physician testimonials for prescription drugs and medical devices are common, featuring a whole hospital department gave Levy pause.

“I was stunned that a public university would allow its name and reputation to be used in that way,” he said, and after reading the university’s website, concluded that the ad violated the university’s code of conduct and administrative procedures, and probably even state law.

Levy began a series in his blog, "Not Running a Hospital,” about the ad. One post read, “The University has allowed its reputation to be used in a nationally distributed advertisement produced and owned by a private party, in benefit to that party's commercial objectives. This is not consistent with ‘exercising custodial responsibility for University property and resources.’”

Later posts noted that some of the white-coated people featured in the ad weren’t doctors, or even medical professionals.

As it turned out, the ad was paid for by Intuitive, and neither the university nor the people depicted were paid for appearing. Still, it was questionable enough that the university asked Intuitive to suspend the ad, and announced it was using the incident as a teaching moment; it promised to assess its policies about these kinds of promotions.

Levy’s indictment didn’t exactly endear him to the university. A university official told ProPublica that the Boston Globe had called out Levy for lapses in judgment over a personal relationship with a female employee when he was with Beth Israel Deaconess. Levy was fined $50,000 by the hospital’s board of directors, copped to his errors and apologized.

ProPublica wanted to know how Levy’s past was relevant to the kerfuffle over the da Vinci ad. The university official said, essentially, consider the source.

As ProPublica makes clear, the cross-pollination of caregivers and device makers isn’t unusual. Hologic Inc. advertised in a trade journal last year using the staff of Methodist Hospitals in Indiana to promote its mammogram machine. Accuray, which makes the CyberKnife, a competitor of da Vinci, offers physician testimonials in its website videos, which don’t disclose if the doctors have been paid.

So although the Illinois University story is muddied with misinformation and drowning in bad blood, you have to get back to basics: When the medical establishment appears to engage in a conflict of interest, it isn’t thinking about patient safety; it’s thinking about its bottom line.

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