Tuesday, September 07, 2004

Eliminating the Middleman......
There are topics which get a great deal of play in the medical blogosphere which have little to do with my surgical practice. Retainer medicine is one and the other is the debate over pharmaceutical issues. I have read with great delight the posts by Galen and Mr. McBride in response to Dr. Centor's call to ban direct to consumer pharmaceutical advertising as well as physician detailing. There isn't much DTC advertising for surgical products, for many reasons. One is the yuck factor. Imagine an ad for an intestinal stapler:
"When the time comes for your colectomy...make sure your surgeon uses the Ajax Mark II linear stapler...The Mark II has the lowest rate of fecal leak of any stapler on the market"
That would go over real well during the dinner hour!
Another is the fact that surgeons sometimes have limited options. Many companies have "saturation contracts' with hospitals. That is, if a device is used, say 80 percent of the time, the manufacturer gives the hospital a discount. Also if many different products by a particular manufacturer are used, a discount is given. The big surgical stapler makers, Ethicon and U.S. Surgical, frequently use such agreements. I remember when the hospital where I trained had a trial of U.S. Surgical suture. They had been using the staplers for years and had been offered a deal if they would buy their suture as well. The trial did not go well for two reasons, one is that surgeons have been trained for years with Ethicon suture and old habits are hard to break, and secondly the USSC suture was awful.
There is also the mechanism for getting new devices into you local OR. One way is a company approaches the purchasing manager of the hospital or OR. This is the approach many companies use when they have a similar device that they claim can beat a competitor on price. If successful they can have their products available for trial, and if enough physicians get behind it the device can be stocked. Another way is a physician is approached by a rep or visits a booth during a meeting. The manufacturer provides some of the devices (i.e. the Ajax stapler) to the physician gratis and if the surgeon likes them, they ask the purchasing manager for it and the request works its way through the bureaucracy and may or may not be approved. For big-ticket items (retractor systems, ultrasound machines, and the like) you usually have to wait for the yearly capital budget process.
But some surgical firms are getting into the act as well. Over the weekend I saw an advertisement for Stryker Ceramics pitching their products for joint replacement, using Jack Nicklaus as a pitchman. I mean if John Elway can shill for Prevacid, why not? So I'm sure some orthopedic surgeon is being pressured to use their product because a patient saw it on TV. SoonZimmer will be forced to respond. I believe things are not exactly as described above for total joint implants, since the patient's insurance is billed directly by the manufacturer rather than the manufacturer billing the hospital which then bills the patient. So DTC advertisement in this situation can influence decision-making. Glad to see we are catching up with the drug makers.
Cross-posted at Galen's Log
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