Deep Throat: "Follow the money" - financial relationships of orthopaedic surgeons

Industry Financial Relationships in Orthopaedic Surgery: Analysis of the Sunshine Act Open Payments Database and Comparison with Other Surgical Subspecialties

These authors sought to describe the industry relationships in orthopaedic surgery using the information now publicly reported in the Sunshine Act Open Payments database.

They found that 12,320 orthopaedic surgeons (50%) had 58,127 industry financial relationships with a total value of $80.2 million. They compared this percentage to other surgical specialties:

Royalties or licensing fees, which were received by 1.7% of U.S. orthopaedic surgeons, accounted for 69.5% of the total monetary value of payments to orthopaedic surgeons. The number of reported relationships and the percent value for the five specialties are shown in the charts below.

Comment: "Follow the money" is a phrase attributed to Deep Throat (aka Mark Felt) the Watergate Scandal informant as portrayed in the film, All The President's Men.

The data shown in this study indicate that there is a major financial incentive for orthopaedic surgeons to develop new implants and new technologies, to speak about them, or to get 'free' food and drink while hearing about them. These new products almost always cost more that their predecessors, yet it is not often clear whether or not these 'advances' lead to better outcomes for the patient. The question 'is the incremental cost offset by the incremental value?" often goes unanswered.

This point is made clearly in the Congressional Budget Office report on "Technological Change and the Growth of Health Care Spending":

"The health care system’s rapid adoption of emerging medical technologies has, in many instances, provided enormous clinical benefits, such as prolonged life and improved quality of life. However, the added clinical benefits of new medical services are not always weighed against the added costs before those services enter common clinical practice. Newer, more expensive diagnostic or therapeutic services are sometimes used in cases in which older, cheaper alternatives could offer comparable outcomes for patients. And expensive services that are known to be highly effective in some patients are occasionally used for other patients for whom clinical benefits have not been rigorously demonstrated.

These findings suggest that some medical services could be used more selectively without a substantial loss in clinical value. Research on comparative effectiveness could provide a basis for applying costly new technologies only when they are likely to confer added benefits that are significantly greater than the benefits conferred by less expensive technologies. If placing greater emphasis on providing evidence-based care (encouraged, for example, by appropriate financial incentives for providers and consumers) resulted in the more selective use of some costly services, future spending levels would probably be lower than they would otherwise be—perhaps substantially so. Attaining significant cost savings, however, may require difficult changes to the ways in which providers and patients make decisions concerning medical care."

Shoulder surgeons have invented systems for 3-dimensional surgical planning, patient specific instruments, bone ingrowth implants, short stemmed humeral implants, stemless humeral implants, resurfacing humeral implants, partial resurfacing humeral implants, humeral implants with adjustable neck shaft angles, metal backed glenoids, augmented glenoid components, pain pump infusion of local anesthetics, patches for augmenting cuff repair, viscosupplementation, laser surgery, radio frequency surgery, and many more (you can see some of the 'advanced' glenoid designs here). We need to assure that these 'technological changes' are cost effective and that they are used appropriately.

Let's make sure that the ways in which we are making decisions concerning medical care is not because we are 'following the money' rather than following the best interests of our patients.

You can find financial relationship information for any U.S. orthopaedic surgeon as shown here.

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Dollars for doctors: sunshine act changing payments for industry to doctors in Minnesota

Medtronic pays 8 physicians $1M+:

Medical device companies based in Minnesota, including Medtronic, paid millions to physicians last year, according to a Star Tribune report.

Here are five key takeaways from the article:

1. Medtronic PLC paid more than $1 million to eight physicians across the country.

2. Medtronic PLC and St. Jude Medical paid physicians $81 million all together

3. In total, physicians and hospitals received $211 million from Minnesota medical device companies.

4. More than 600,000 physicians and 1,100 hospitals accepted payments last year; the payments totaled $6.49 billion covering consulting, gifts and honoraria, royalties, stock dividends, travel and dining.

5. Last month, the University of Minnesota banned most types of payments after criticisms that payments create financial incentives and conflicts of interest for research programs.

See related post in this link.

And here is a related press release from Philadelphia

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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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Industry payments to doctors revealed - the 'Sunshine' act

Docs fear Sunshine Act data may be misread

The Sunshine Act appears as Section 6002 of the Patient Protection and Affordable Care Act has as its goal to create a national transparency program for payments made to physicians and teaching hospitals by drug and medical-device manufacturers and group purchasing organizations. The Centers for Medicare and Medicaid Services (CMS) reports that more than 90% of physicians have some type of business relationship with industry sources. Pharmaceutical companies are reported to have spent $15.7 billion in 2011 on sales and promotional activities.

Beginning Aug. 1, drug and device companies will need to start keeping track of transfers of value worth more than $10 to physicians and teaching hospitals. Physicians will have the opportunity to review what is reported about them in the second quarter of next year, and the reports will be made public on Sept. 30, 2014.

The Act attempts to address concerns regarding conflicts of interest, noting that 60% of physicians reporting an industry relationship are involved in medical education and 40% are involved in creating clinical practice guidelines.

While the prospect of these relationships being made public is troubling for some physicians, their revelation is important be cause fiscal conflicts of interest can affect the way doctors practice, do research and teach. See here, here and here.

See also Baucus-Grassley Investigation into Medtronic Reveals Manipulated Studies, Close Financial Ties with Researchers from the U.S. Senate Committee on Finance. Here's a quote from that report, "Without public disclosure of their roles, Medtronic employees collaborated with physician authors to edit – and in some cases, write – segments of published studies on its bone-growth product InFuse. The studies as published may have inaccurately represented InFuse’s risks and may have placed added weight on side effects of alternative treatments. Medtronic, which describes itself as “the world's largest independent medical technology company,” also maintained significant, previously-undisclosed financial ties with physicians who authored studies about InFuse, making $210 million in payments to physicians over a 15-year period"


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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'





See from which cities our patients come.







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