Is your surgeon able to understand simple instructions?

I like to think that most surgeons are very brainy people. You don’t get through all those years of university, med school and residency unless you’re able to understand instructions. Yet that’s what a puzzling 29% of orthopedic surgeons were apparently unable to do, according to a conflict-of-interest study reported in the New England Journal of Medicine.

It all started when, in order to avoid facing legal action, several companies who manufacture hip and knee implants agreed in 2007 to publicly disclose about $270 million worth of cash payments they’d made to orthopedic surgeons.

This agreement was part of a U.S. Justice Department investigation in which prosecutors accused these companies of violating anti-kickback laws by paying the physicians to use their products. This concerned the researchers, who said they felt a duty to alert the public to potential conflicts of interest that may colour how doctors treat patients when docs are on the take from product manufacturers

In the NEJM report, researchers looked at all surgeons doing presentations at the March 2008 annual meeting of the American Academy of Orthopedic Surgeons. They asked these surgeons if they had received any payments from five companies that make hip and knee replacements, and then they compared the surgeons’ answers with the actual list of surgeons’ payments provided by the five companies themselves.

Well, it turns out that researchers found that among 344 cash payments to surgeons disclosed by the five companies, only 245 of these payments were disclosed by the recipients.

This means 29% of payments weren’t properly disclosed by the docs.

For the sake of clarity, let’s just call this ‘lying’.

In fact, more than $4 million in payments directly related to the subjects of the surgeons’ conference presentations were not even disclosed.

That’s $4 million worth of very effective targeted product marketing – when orthopedic surgeons are willing to stand up at a professional conference and tell other orthopedic surgeons about devices and products that the manufacturers are paying them to endorse.

Dr. Mininder Kocher, a Harvard Medical School orthopedic surgeon who participated in the study, told the Wall Street Journal at the time:

“We were a little surprised at how high the non-disclosure rate was. Some of that might have been intentional and perhaps people shouldn’t be trusted, but I think the big part is it’s very confusing how self-disclosure happens now in scientific meetings and in journals.”

Confusing?  Well, maybe it is confusing for those who just fell off the turnip truck, but if even I, a dull-witted heart patient, can figure out what a corporate kickback looks like, I’m wondering how difficult this can possibly be for brainiacs with the letters M.D. after their names to understand.

The fact that the popularity of these industry kickbacks to orthopedic surgeons sunk like a stone after the manufacturers agreed to start naming names of recipients does tend to diminish the researchers’ theory that the brainiac surgeons were just “confused”.

Payments fell sharply when the court-mandated agreements took place — from $272 million in 2007 to $105 million in 2008. In fact, the total number of orthopedic surgeons receiving payments from these companies went from 1,693 in 2007 to 628 in 2008.

But now I’m confused.

If this practice of offering kickbacks to surgeons to push your products is merely your basic sound business practice, why wouldn’t the cash payments continue?  The toothless legal requirement was just to disclose the payments – not to stop them entirely.

Or have all of them just figured out a new improved way to avoid disclosure?

Read the study published in the New England Journal of Medicine.

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7 thoughts on “Is your surgeon able to understand simple instructions?

  1. Pingback: Arthritis Blog

  2. It’s so difficult to be a surgeon. So many facts clogging your brain that it can be hard to understand simple questions like “Did you or did you not take money from the drug/device industry?”

    This is a very complex kind of question that can be impossible to answer truthfully. Give the poor orthopods a break, okay? 😉

  3. I THINK my surgeon is smart enough to answer YES or NO to these kind of questions, but perhaps orthopedic surgeons have a harder time understanding the complexities of the question?!?!?

    Thank you for this info – there is a wealth of interesting stuff on your site on so many marketing subjects.

  4. Pingback: O.R. Stories

  5. Yet another very interesting article. I’m a new subscriber to your website – because I always learn something intriguing. Who knew, for example, that so many orthopedic surgeons don’t know how to read?

    • Augusta – “Who knew, for example, that so many orthopedic surgeons don’t know how to read?”

      Enough with the sarcasm already. Next time you need a broken bone set or a hip replaced, let’s see if you’re going to be such a smart ass right to your orthopod’s face.

  6. “…it’s very confusing how self-disclosure happens now in scientific meetings and in journals…” Really? Why were the study authors not able to come up with a conclusion that’s actually based on reality instead of this gutless defense of their colleagues? This sounds like it was a basic YES or NO question. Surgeons who take money from industry in exchange for using their devices know perfectly well whether or not they’re taking the money. Disgusting.

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