Let the Patients Beware

Patients have a right to know who is paying their doctors before they agree to a procedure. Caveat emptor — let the buyer beware — should never apply to medicine.

Yet this simple concept is lost on too many highly paid orthopedic surgeons, who have been paid millions of dollars by medical device makers, and on the medical journals for which they write.

A study published online this week in the Archives of Internal Medicine found that 46 percent of surgeons who were paid at least $1 million from five device manufacturers in 2007 did not disclose the relationship in articles published later.

Mandated public disclosure of payments is coming in 2013 when the Physician Payments Sunshine Act takes effect, but why can't docs and journal editors set a better example now? We suspect the reason has much to do with those millions of dollars flowing to the surgeons. Those payments, likely intended to ensure that a certain product is used, play a role in driving up the cost of health care. The payments cast doubt on the judgments of physicians.

In 2007, the study found, 41 surgeons and researchers were paid $114 million by Biomet, DePuy, Smith & Nephew, Stryker and Zimmer.

The payments averaged $2.8 million each, although some doctors received far more than that. The companies were required to disclose the payments to avoid criminal prosecution as part of a $311 million settlement with the U.S. Justice Department. Justice had accused the manufacturers of routinely violating the anti-kickback law by paying surgeons to use their products exclusively. These side deals were not disclosed to either patients or hospitals.

As part of his "Side Effects" investigation, Milwaukee Journal Sentinel reporter John Fauber uncovered similar inconsistencies last year at the University of Wisconsin-Madison. In a spot check of about 40 UW physicians, the newspaper found that information listed in published articles by at least nine of them did not match their financial disclosures to the university.

The Archives of Internal Medicine article deplores "the inadequate transparency produced by current disclosure practices" and suggests that medical journals collect comprehensive information about the ties writers have to industry and adopt a common disclosure standard that includes the size of payments.

We're also open to tougher measures, including an outright ban, if it could be done without discouraging innovation. In the meantime, transparency, please.

REPRINTED FROM THE MILWAUKEE JOURNAL SENTINEL.

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