Wednesday, March 12, 2008

Melbourne public hospitals and surgeons investigated for kickbacks

The tendering process appears to have been bypassed in 2 leading Melbourne public hospitals, giving a couple of medical equipment companies exclusive usage rights in these institutions.

According to The Age “donations” ranging from $75,000 to $250,000 have bought a number of US medical devise manufacturers the rights to having their products being used in these hospitals, to the exclusion of all other suppliers. With contracts for supply far outstripping the initial tax-deductible donation, this kind of business incentive is not new in the medical world. However such anti-competitive practices in a publicly funded hospital is certainly questionable if not illegal.

Individual surgeons have also been allegedly supplementing their meagre wage with direct kickbacks from some of these companies, for choosing their products. “Incentives” for doctors to prefer a certain pharmaceutical company or medical device manufacturer have long included rewards such as holidays and other luxuries. Though lets not forget the little folk, many disease or medical condition support groups are indirectly funded by similar companies to allow these shoestring organizations to continue to keep their advice lines and other referral services open.

Strangely the AMA has come late to this. Only after an official US based investigation blew the whistle on what has been happening in Melbourne, has our medical ‘watchdog’ (or rather protection group) made a statement “to call for greater transparency in the relationship between the implant makers and surgeons.”

The AMA Code of Ethics always makes interesting reading. Does your GP or specialist have one on display in their waiting room for you to peruse before your consultation? (It’s ok; they are not obliged to by the code). In regards to incentives and kickbacks things are not spelt out directly, the closest are references in Professional Independence to: “refrain from entering into any contract with a colleague or organisation which may conflict with professional integrity, clinical independence or your primary obligation to the patient” and “recognise your right to refuse to carry out services which you consider to be professionally unethical, against your moral convictions, imposed on you for either administrative reasons or for financial gain or which you consider are not in the best interest of the patient.” Hey if there is a financial incentive to use a certain medical device or drug you are allowed, though not obliged, to refuse it.

A press release from the AMA in 2004 acknowledges that medical companies target doctors even before graduation with sweeteners to medical students and that 80-95% of doctors regularly agree to see industry reps. More alarmingly the statement acknowledges that “studies demonstrate that attendance at conferences sponsored by the industry produces altered prescribing patterns for at least the next six months” yet has not made any stand to make ongoing education for professionals truly independent.

A further position statement regarding a doctor’s relationship with the pharmaceutical industry states: “Doctors in practice should not accept a fee or equivalent consideration from pharmaceutical manufacturers, distributors, etc. in exchange for seeing them in a promotional or similar capacity" and "practising doctors should not accept, nor allow their prescribing habits to be influenced by, personal gifts from the pharmaceutical industry or similar bodies.”

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