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Q&A with Dr. Charles Rosen: Money, Ethics, Medicine...and Maybe a New Surgeon General
March 29, 2009
This UCI orthopedic surgeon is on the shortlist for the U.S. Surgeon General job. He has been an outspoken critic of medical device companies and is fighting to limit the influence of money on medicine.
Here is a recap of our conversation:
Q: You were in Washington last year testifying before Congress about doctors who are paid by companies to put in certain medical devices. Did they understand why you were so concerned about this?
A. The Special Committee on Aging was discussing the Physician Payment Sunshine Act, which would require all device and pharmaceutical companies to list on their Web site the names of the doctors who are consultants as well as how much they are getting paid. A lot of devices have papers written about them and studies published, and other doctors and patients don't understand who the authors are and how much they are earning from the companies that make these devices. The act hasn't passed yet, but we're hopeful.
Q: How do you know that these devices aren't the best solutions for these doctors' patients?
A: Let me give you an example of something called the X-Stop Spacer. It came out a few years ago. It's supposed to be put in easily to spread the vertebrae apart a little bit instead of doing a more invasive surgery. When you look at the early papers on the device saying it was great, those were written by people who are involved in it financially. When you look at the reviews from people who are not involved financially, you can see beyond a year or two that it was failing at a high rate. Independent authors took a very cautious view.
Q: How would it have made a difference if people knew about the money being made by these medical authors?
A: If people who read the paper knew the financial ties of the doctor who wrote the paper they wouldn't have jumped to use it. The hallmark is independent validation. You would think that all the medical societies would be lining up to endorse this idea, but they're not. So we had to set up an independent organization.
Q; And that's the Association for Medical Ethics.
A: Right. We stand for transparency and disclosure. Our second function is to promote evidence based medicine. We have signed up more than 250 doctors who have become members from 11 different countries. They are signing an affidavit online that says they don't accept money from industry.
Q: With the evidence-based medicine piece, you are giving star ratings, right? Isn't that a little like a restaurant review or a movie review?
A: People seem to really appreciate it. We're taking something really complicated and we're asking, "What is the predictive value of success for a procedure based on the literature?" We have evaluated about 10 procedures, and we're hoping to do more each month. You have to look at 40 or 50 articles and then rate the procedure.
Q: At the same time, you helped put together this Web site that lets people see exactly what their doctor has been paid, if anything, by some of the biggest names in medical devices: Stryker, Dupuy and others. How did that come about?
A. These companies all struck these sort of plea bargains with the federal government, which was looking at prosecuting them for these secret deals they had with surgeons. They were flying surgeons around, taking them out to dinner and paying them cash outright to promote their products. But the patients were never told about it. As part of the settlements, they had to post this information on their Web sites. We take it all and put it in one place and give people a way to search by their doctor's names.
Q: One of the vice presidents for the major orthopedic medical society, the American Academy of Orthopedic Surgeons, made more than $2.6 million in payments and other contributions from Dupuy. What do you say to a guy like that when you run into him at a conference?
A. It's already public knowledge. We're just making it easier for people to find. The guidelines for the AME are that if you're going to be in a position of professional leadership, you should not be collecting more than $50,000 from any outside industry source. Otherwise you are too biased. When you are in the position of directing the flow of public health information, you cannot be making unbiased decisions if you are making more than millions. If he has a problem with it and wants to come after me, let him. He's already tried to get me fired.
Q: What does your boss at UCI have to say about all this?
A: He says, "Tell me what Dr. Rosen has done that is wrong, unethical or illegal?" The gist of their complaint is that I'm disrupting the practice of orthopedics and spine medicine. In parentheses they mean "He's stopping me from getting my money."
Q: Why would you be a good surgeon general?
A: You need to look for what a candidate is going to bring to the health of the American public. What I've done for the past four years is focus on improving the health of the public to stop the inappropriate and wasteful use of all these devices that are being pushed by the medical industry. The public should feel like when a doctor recommends a procedure that they're doing it because it's the best thing for the patient not just for them financially. The revelations just recently that psychiatrists have been paid millions for pushing these drugs that may not work for bipolar disorder or ADD is just terrible. That's exactly the kind of issue I would want to put on the agenda.
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