Thursday, November 12, 2009

The Business Of Medicine

The Boston Globe continues to publish articles on the way pharmaceuticals and medical equipment manufacturers buy their way into the practice of medicine. The latest involves a law suit against Lahey Clinic in which a cardiologist claims he was fired because he fought against pressure brought by two senior colleagues to use a particular heart stent which he thought was not always the best one for his patients.

Dr. David Gossman, who worked at Lahey for more than 20 years, alleged in a lawsuit filed last month that Dr. Richard Nesto and Dr. Thomas Piemonte pressed him and other cardiologists to use Medtronic stents, because they believed if the hospital increased its use of the product, Medtronic would let Lahey participate in clinical trials for a new heart valve. Trials of the CoreValve are scheduled to begin next summer. Testing medications and devices can help hospitals and physicians attract patients.

Gossman, who lives in Westford, also said in the lawsuit - filed against the hospital and the two doctors in Massachusetts Superior Court - that Piemonte has financial ties to Medtronic. Piemonte is director of interventional cardiology and sits on Lahey’s “inventory committee’’ for the catheterization lab, which chooses products and approves contracts with companies.


The clinic denied the firing was connected to Dr. Gossman's refusal to use the stents, but at the same time revealed the ties between at least one of the physicians and Medtronic:

Lahey spokesman Steve Danehy said yesterday the hospital’s corporate compliance department investigated the allegations and found them to be “totally groundless.’’ Gossman, he said, was dismissed for “misconduct’’ that occurred months before he said he was pressured to use Medtronic stents. ...

Danehy said Piemonte is a member of Medtronic’s speakers bureau - he receives payments from the company to lecture to other physicians about their products - and that the wives of both Piemonte and Nesto own stock in Medtronic. Piemonte’s wife is a sales representative for the company and sells pacemakers and defibrillators but does not do business at Lahey, Danehy said.
[Emphasis added]

Excuse me? Is there an outbreak of olfactory nerve damage among the clinic's officials? Even from the West Coast that description of the ties between Medtronic and the two senior cardiologists smells bad, especially given the medical equipment maker's recent history:

Minneapolis-based Medtronic has been embroiled in ethics scandals in the past several years. In 2006, the company reached a $40 million settlement with the federal government over accusations it paid illegal kickbacks to doctors for using its spinal devices.

And earlier this year, a doctor who was a consultant to the company published a study that made false claims about a Medtronic bone-growth product, saying it had much higher success in healing the shattered legs of wounded soldiers at Walter Reed Army Medical Center than other doctors there had experienced, according to Army investigators.


Now, it may very well be that Dr. Gossman was terminated for cause, in which case he'll lose the lawsuit, but Lahey Clinic, by allowing for such arrangements as described in the article, sure gave him a rather nifty way to leave his former employer with one sizable black eye. It also gave the Boston Globe a chance to underscore once again just how the practice of medicine is affected by the marketing departments of companies such as Medtronic.

There oughta be a law ...

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