Thursday, October 13, 2011

Left to Our Own Devices...

In case you missed it, let me direct your attention to a recent page-one story in The Wall Street Journal. The article documents a growing trend among surgeons to implant their own medical devices into the bodies of their patients. As a result, the surgeons stand to profit twice: once from the surgery and again from the sale of the device.

The surgeons, as you might suspect, say the prospect of making money (even lots of money) doesn't influence their medical decisions. A lawyer for one of the surgeons is quoted in the article as saying the surgeon used his own devices because they "were the best on the market for the procedure" and not because he stood to profit from them.

Perhaps. But nearly every piece of research on the subject points the opposite way.

First of all, most of us don't like to admit we're biased. Our colleagues? Oh sure, we're happy to admit they might be influenced by such things as money. But not us. A 2001 study of medical residents, for instance, found that 84 percent thought that their colleagues were influenced by gifts from pharmaceutical companies...but only 16 percent thought that they were similarly influenced.

The interesting thing is that bias is seldom a matter of deliberate choice.It is typically unconscious and unintentional. Research has shown that professionals who sincerely believe that their decisions are “not for sale”(such as physicians) are still biased in the direction of self-interest.

Even those who are purportedly neutral have been shown to be biased. A 2005 study of psychiatric drug trials found that when academic researchers were funded by a drug company, they were nearly five times as likely to report that the treatment was effective.

Likewise, a 2003 study by economists at Carnegie Mellon and Harvard found that independent auditors were significantly more likely to approve questionable accounting practices when those practices were done by the firm paying their bills.

And it doesn’t take much to bias someone’s judgment – even a coffee mug will do. Students at a medical school where gifts such as coffee mugs and pens are permitted from drug companies had a more favorable attitude toward a cholesterol drug than did students at a medical school where such gifts were banned.

So if you're due for surgery any time soon, ask your surgeon about his or her financial interests in the surgery. As the Journal article pointed out, doctors don't always disclose these. One man died shortly after receiving implants from a doctor who stood to profit from them. His widow says she would have liked to have known this before the surgery.

"It might have caused me to ask: Is the surgery really necessary, or is he out to make more money?"

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