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| Association for Ethics in Spine Surgery Live Web Chat Thursday, December 20 from 5:30 pm to 7:30 pm (PST) - Full Transcript |
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Chat moderators included:
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| Pete Sorini says: | 12/20/2007 20:33 |
| Hi everybody. I am a neurosurgeon in Montana. I am halfway through a health care MBA from GWU. Very interested in ethics and spine surgery. | |
| Merrill Reuter says: | 12/20/2007 20:36 |
| Hi Peter, Welcome | |
| Merrill Reuter says: | 12/20/2007 20:37 |
| does anyone have any specific questions for us | |
| C.J. Powell says: | 12/20/2007 20:38 |
| Hello Dr. Rosen, When did you start the Association? How many members do you have so far? | |
| Dr. Charles Rosen says: | 12/20/2007 20:38 |
| We started the Association in May 2005 and todate we have more than 250 members and members to be | |
| Dr. Charles Rosen says: | 12/20/2007 20:39 |
| Peter --- would you like to post your question again, now that we're up and running | |
| Dr. Charles Rosen says: | 12/20/2007 20:41 |
| Welcome to the Association for Ethics in Spine Surgery's first live Chat. With us tonight are AESS board members Drs. Charles Burton, Merrill Reuter and David Morgan. Our special guest is Jack Mitchell Chief of Investigations for the Senate's special committe on aging. Feel free to ask us any questions. | |
| Pete Sorini says: | 12/20/2007 20:43 |
| Sure Dr. Rosen. How can we decide if a procedure is necessary when ultimately we base our decisions upon what a patient tells us? Can we legislate morality? | |
| Dr. Charles Rosen says: | 12/20/2007 20:45 |
| Our job as physicians is to base our decisions on medical evidence without the undue financial bias particuarly that of outside interest, such as companies with an outside interest. We can legislate that in a sense but not morality. | |
| C.J. Powell says: | 12/20/2007 20:45 |
| Mr. Mitchell: How are the Senate investigations going? | |
| Jack Mitchell says: | 12/20/2007 20:49 |
| Our ongoing inquiry is part of months long investigation that began in the spring and started off with a hearing in late June. Our intent was to hold several hearings over a long period of time to examine ethics and conflict of interest issues in the pharaceutical and medical device industry. We are planning a second hearing in early 2008 which will focus on these issues as they relate to the medical device industry. We're actively conducting interviews and exchanging information on a wide ranging basis. We welcome input from anyone out there. | |
| Don says: | 12/20/2007 20:55 |
| Which physician are Jack Mitchel's Senate Investigating targeting? | |
| Jack Mitchell says: | 12/20/2007 20:56 |
| I'm not saying we're targeting any specific surgeons or physicians at all. | |
| Jack Mitchell says: | 12/20/2007 20:57 |
| It's pretty apparent to the committee that the Justice departments investigation of the Orthopedic industry extends to physicians and surgeons. | |
| Pete Sorini says: | 12/20/2007 20:57 |
| I think the problem is clearly bigger in academia where high-powered clinicians lend their names to some quasi-investigational study, endorse the product, and then receive royalties. I do not see a lot of conflict in the private sector but I only have a limited perspective. | |
| Dr. Charles Rosen says: | 12/20/2007 21:02 |
| I would agree partically with you and I say that as a Clinical Professor of Orthopedic surgery at UCI. Probably over half of all chairman of departments at universities have consultancy fees from industry as a recent paper showed. We do not here at UCI's department. I see that as a big danger in the unchallenged acceptance of any such data which comes out of University and does not have disclosure of the dollar amounts that are received by such faculty or not. However, the private sector is still writing and pushing the majority of spinal devices by those that are being paid by industry. | |
| Rob Lieberson says: | 12/20/2007 21:02 |
| Are you looking at any of the drug companies or distributors? | |
| Jack Mitchell says: | 12/20/2007 21:03 |
| Yes, we are looking at drug companies and distributors. That issue was addressed at our June 27th hearing and also in our legislative proposal. These are under consideration. | |
| C.J. Powell says: | 12/20/2007 21:07 |
| Dr. Rosen - How much resistance have you encountered since you started the Association? | |
| Jack Mitchell says: | 12/20/2007 21:08 |
| Yes, a stunning amount from the most surprising places where one would think freedom of speech and academic debate would reign. | |
| Dr. Charles Rosen says: | 12/20/2007 21:11 |
| I too have had enormous animosity from academics, professors, chairman who outwardly profes to debate the issues when in reality it seems the pocketbook is where the real power is. It's dissappointing. | |
| Dr. Charles Rosen says: | 12/20/2007 21:13 |
| The private sector industry paid MD's who feel their $ is the most threatened have been even more vocal. It has become like dirty politics and most people would be stunned to know what's going on and who's doing what. | |
| Pete Sorini says: | 12/20/2007 21:15 |
| The health care - industrial complex is changing. The manufacturers and the drug companies are taking their multimillion dollar marketing plans directly to the consumers. The baby boomers are showing up in our offices with literature from the internet or even from the daily newspaper expousing the virtues of this or that device or drug. This is the tip of the iceberg. | |
| Don says: | 12/20/2007 21:15 |
| Dr. Rosen, are you paid by industry for anything? | |
| Dr. Charles Rosen says: | 12/20/2007 21:16 |
| Absolutely not now, in the past, nor plan to in the future. | |
| Pete Sorini says: | 12/20/2007 21:17 |
| There cannot be that many private industry docs that carry the credibility to endorse a product. Can there? | |
| Merrill Reuter says: | 12/20/2007 21:17 |
| Yes | |
| Merrill Reuter says: | 12/20/2007 21:19 |
| There can be a lot of private sector docs that are using and espousing devices that they have vested interest in. It is not just academia. | |
| Jack Mitchell says: | 12/20/2007 21:22 |
| From a non medical perspective or a government oversight perspective all surgeons have a great credibility wtih the public at large. And patients do not know nor understand in most cases the underlying financial conflicts when a surgeon and physician are promoting a device or medication. Patients have no way of knowing. That is what our on going hearings and legislation are addressing. | |
| Brian2 says: | 12/20/2007 21:23 |
| Dr. Reuter, are you paid by industry for anything, or do you have ownership in any healthcare delivery facilities? | |
| Merrill Reuter says: | 12/20/2007 21:25 |
| No | |
| Merrill Reuter says: | 12/20/2007 21:25 |
| I am not paid by any device manufacturers | |
| Merrill Reuter says: | 12/20/2007 21:26 |
| though I am a non paid chairman of the board of a public company | |
| Merrill Reuter says: | 12/20/2007 21:28 |
| of which I do have stock in | |
| Carter says: | 12/20/2007 21:30 |
| What is the penalty for a doctor being part of a distributorship...if anything? | |
| Dr. Charles Rosen says: | 12/20/2007 21:33 |
| If the distributorship violates the anti kickback statutes then it is a felony. This response is from all on the committee. | |
| Patrick says: | 12/20/2007 21:34 |
| Hello group. I am just joining. No financial relationships to disclose. I'm in academics now, but when I was in practice there was a disclosure as part of the new patient packet for our group. This stated that some surgeons in the group may have a financial interest in some of the materials being used. | |
| Dr. Charles Rosen says: | 12/20/2007 21:34 |
| Do you have a question?? | |
| Ron says: | 12/20/2007 21:34 |
| Can you tell me how this impacts having spine surgery? I saw the press release for this chat, and because my brother is set to have spine surgery, I wanted to see this. | |
| Merrill Reuter says: | 12/20/2007 21:37 |
| The only negative impact is if the surgeon has an inappropriate bias based on financial aspects and fails to choose or offer the best treatment for your brother | |
| Pete Sorini says: | 12/20/2007 21:37 |
| Is it a conflict of interest for physicians to have ownership interest in surgery centers, imaging centers, or specialty hospital or is it just good business. | |
| Jack Mitchell says: | 12/20/2007 21:38 |
| That raises a very good question that should be looked at, and we on the committee will be looking at this. | |
| C.J. Powell says: | 12/20/2007 21:39 |
| Which chat room gives the best unbiased information on spinal surgery? | |
| Jack Mitchell says: | 12/20/2007 21:45 |
| Most online seem to be industry sponsored and moderated to exclude criticism of the device in question . The gist is that these people running it are very warmly concerned about the patients logging in. Yet I believe that is far from the truth. | |
| Ron says: | 12/20/2007 21:46 |
| Wow, I'm not sure what that means at all.... I'm sorry. | |
| Carter says: | 12/20/2007 21:47 |
| Do you think that most of these chat rooms are run by the medical device companies... | |
| Dr. Charles Rosen says: | 12/20/2007 21:48 |
| Carter --- I would say that they are sponsored by --- not necessarily run by medical device companies. The moderators may have hidden financial agendas that the posters will not know about. | |
| Merrill Reuter says: | 12/20/2007 21:48 |
| Ron, the existence of inappropriate bias depends on what the surgeon is proposing | |
| Don says: | 12/20/2007 21:49 |
| Jack Mitchell: How will a patient know if their doctor has ownership interest in surgery centers, devices etc... | |
| Don says: | 12/20/2007 21:50 |
| What does the AESS intend to do as an organization? | |
| Art says: | 12/20/2007 21:51 |
| Device in question ? | |
| Dr. Charles Rosen says: | 12/20/2007 21:52 |
| Most any, but particularly most of the disc replacement "support " groups | |
| david f. morgan says: | 12/20/2007 21:52 |
| i think the simplest approach is to ASK the doctor with assumption that you will receive an honest aand complete answer. | |
| Merrill Reuter says: | 12/20/2007 21:52 |
| Don - hopefully AESS can help improve the care and treatment that patients receive from their doctors. That the care will be what is best for the condition, not the remuneration to the physician | |
| Charles Burton MD says: | 12/20/2007 22:01 |
| AESS' hopes to assist MD's that have lost sight of what their profession is really about.. As Lilly Tomlin said "you can't do the right thing unless you know what it is." Our purpose is to educate - or to remind our profession. | |
| Dawson MD says: | 12/20/2007 22:01 |
| Jack Mitchell: I just joined the group, when is the next Senate hearing? | |
| Jack Mitchell says: | 12/20/2007 22:02 |
| It has not been scheduled yet, but we hope it will be in late Jan or early Feb. | |
| Dr. R. Miller says: | 12/20/2007 22:02 |
| Dr. Rosen: Are you affiliated with Medtronics at all? | |
| Dr. Charles Rosen says: | 12/20/2007 22:04 |
| In no way, shape or form have I ever accepted any money, stock, or the like from anyone, including Medtronics. | |
| Don says: | 12/20/2007 22:05 |
| Merrill Reuter: How does AESS tend to do that? | |
| Dawson MD says: | 12/20/2007 22:05 |
| To Jack Mitchell: How will we know when it will be scheduled. Will AESS announce on their website? | |
| Jack Mitchell says: | 12/20/2007 22:07 |
| It will be posted on the website for the US Senate Special Committee on Aging a week or ten days prior to the hearing. | |
| Dawson MD says: | 12/20/2007 22:08 |
| Can you give me that website address. | |
| Jack Mitchell says: | 12/20/2007 22:09 |
| US Senate Special Committe on aging | |
| Merrill Reuter says: | 12/20/2007 22:10 |
| AESS will continue to serve in an educational capacity to inform its members of the biases that can affect physician decision making and try to minimize the inappropriate effects of powerful industry driving the treatment decisions | |
| Teresa says: | 12/20/2007 22:11 |
| the site is aging.senate.gov | |
| Merrill Reuter says: | 12/20/2007 22:11 |
| And encourage the disclosure of treatment alternatives by physicians to their patients in outlining the aspects of informed consent | |
| Dawson MD says: | 12/20/2007 22:11 |
| Thank you for the information. | |
| Charlie says: | 12/20/2007 22:12 |
| Implant companies recently disclosed physician names and dollar amounts of payment received. Does anyone know where that information can be located? | |
| Jack Mitchell says: | 12/20/2007 22:13 |
| On the website of each of the 5 companies that made a settlement with the DOJ . Namely, Stryker, Biomet, Smith and Nephew, Zimmer, Depuy | |
| Dawson MD says: | 12/20/2007 22:14 |
| Just curious, has anything been addressed about the Charite Disc? | |
| Dr. Charles Rosen says: | 12/20/2007 22:15 |
| No discussion thus far. | |
| Charlie says: | 12/20/2007 22:16 |
| Thanks will look it up | |
| C.J. Powell says: | 12/20/2007 22:16 |
| Dr. Rosen: What exactly is wrong with the Charite Disc? | |
| Dr. Charles Rosen says: | 12/20/2007 22:18 |
| I would refer you to the paper I posted on our website at EthicalSpineSurgeon.org - or IJMIST.com | |
| Dr. R. Miller says: | 12/20/2007 22:18 |
| Why hasn't the FDA been more proactive? | |
| Jack Mitchell says: | 12/20/2007 22:20 |
| As a former FDA advisor, I can say they do not have the resources sufficient to police all of the issues. Moreover, there is significnant pressure from industry against the FDA being proactive in its oversight of these issues. | |
| Carter says: | 12/20/2007 22:22 |
| Dr. Rosen: How did you become so involved in this cause? | |
| Dr. Charles Rosen says: | 12/20/2007 22:23 |
| Charite disc replacement data and patients. | |
| Powell MD says: | 12/20/2007 22:26 |
| Dr Rosen, do you serve as an expert witness in tort cases involving the Charite Disc? | |
| Dr. Charles Rosen says: | 12/20/2007 22:28 |
| I have given my opinion to two lawyers in the past 3 years about disc replacements , the last of which was 6 months ago. and btw, I do not testify in malpractice cases. | |
| Art says: | 12/20/2007 22:28 |
| As a surgeon I would say that it highly unlikely that an organization of any type is going to be successful in reminding any MD what their profession is about if that is a point that has faded from their memory or that was never there at all. The lack of objective self refection and evaluation often combined with incompetence will always be there. If a physician cannot see salespersons for what they are, and a company for what it is, no one and no group is going to change that. | |
| Dr. Charles Rosen says: | 12/20/2007 22:30 |
| This webchat ends at 7:30 so I will make closing comments here and thank all for participating. As far as Art's comment, we at least need to try to make a difference. | |
| Dawson MD says: | 12/20/2007 22:31 |
| Obviously an organization is needed to remind doctors of just that point based on how much money they're making from these medical device companies. | |
| Powell MD says: | 12/20/2007 22:31 |
| Art, I'd agree, with the caveat that we are often driven in our choices by patient desire as well. Since I was a resident in the 80's I have had patients asking for an "artificial disk" | |
| Dr. Charles Rosen says: | 12/20/2007 22:32 |
| All these posts btw that were made tonight will be put into an AESS blog on our website for future comment | |
| Powell MD says: | 12/20/2007 22:32 |
| Thanks everyone. I hope we do this panel again. | |