Conflicts and Interests

One of the little-noticed elements of the recently passed health care reform legislation in the U.S. is the incorporation of the physician payment sunshine act, which forces medical device and pharmaceutical manufacturers to report just about any kind of payment made to or on behalf of physicians. The bill was put forward largely at the behest of Sen. Charles Grassley (R-IA), despite the fact that he did not vote for the final health care bill. The provision requires manufacturers to report any payment greater than $10, including meals, drinks, speaking fees, consulting fees, travel—even charitable contributions.

We’re all in favor of ethical behavior on the part of health care providers and manufacturers and patients have a right to know if the medical advice they are being given is in any way influenced by relationships they might have with product vendors. But the way the law zeroes in on clinicians while ignoring more gaping examples of conflicts of interest in the healthcare industry is disturbing.

At the recent annual meeting of the Medical Device Manufacturers Association in Washington, D.C., Josh Makower, founder of ExploraMed Development, pointed out examples of “real conflicts of interest” that impact startup and emerging medical firms, such as political power within professional societies, academic prestige, and the need to be “right.” During the meeting, several device companies cited examples.

One of the most potent concentrations of power in the medical device industry lies within the AMA CPT editorial panels, which determine which procedures will be granted a CPT code. Other panels determine the amount of reimbursement resulting from such codes, decisions generally rubber-stamped by the Centers for Medicare and Medicaid Services. One manufacturer of artificial spinal discs noted that the reimbursement for a spinal fusion procedure was double that for a cervical disc implantation, despite the similar length and nature of the two procedures. This reimbursement disparity, which made it much more likely that surgeons would opt for the fusion procedure over the artificial disc, was attributed largely to the obstinance of one powerful panel member who held considerable weight within a professional society.

Other speakers pointed out examples of large health insurance companies who made non-coverage decisions but refused even to meet with the manufacturers of the devices involved. And there are numerous examples of approval and reimbursement decisions being influenced by academics motivated by animosity towards another researcher.

None of this is to suggest that financial disclosure of payments to physicians is not a good idea. We just think that the government and the public should be aware of influences that are peddled for motives other than cash.

James Cavuoto
Editor and Publisher