Wednesday, December 30, 2009

Old News Is, Well Old News!

On December 24th, the Journal Sentinel a Milwaukee, Wisconsin newspaper ran a story "Journal editor gets royalties as articles favor devices" which discussed Tom Zdeblick's consulting relationship with Medtronic Sofamor Danek (MSD) and a potential conflict of interest considering he has been the editor-in-chief of the Journal of Spinal Disorders and Techniques since 2002.

Zdeblick has been an MSD spokesperson and salesman for many years, (I don't remember him ever going through sales training) earning an estimated $20 million dollars in patent royalties.
The reporter, John Fauber, questioned why the readers of JSDT were never informed that Zdeblick, aka Zig Ziglar, was a consultant for the company. Unfortunately, this question should have been asked many years ago. Old news is, well, old news. Mr. Fauber, an industry outsider, must understand that most of us that actually read spine publications have been laughing at Tom for many years, while he has been laughing all the way to the bank.

Six years ago, TSB was sitting in the audience at a spine symposium in Florida when Tom got up to speak about cervical spine disorders. In an instance, a clinical presentation turned into a promo for Medtronic's then new cervical plate. If you closed your eyes you almost felt like it was Dan Aykroyd selling the The Super Bassomatic 76. If Saturday Night Live ever revives this skit, I know just the right guy to play that role. The pathetic side to this story is that most of us, including surgeons, started to snicker about the study let alone Tom's sales pitch. Surely some laughed with envy.

TSB has no problem with Zdeblick getting paid for products that he truly developed. What bothers TSB and others is that as editor-in-chief he is potentially using his clout in publishing studies that commercially benefit Medtronic and financially benefit himself. Would he publish an article that compares the clinical efficacy of a Medtronic plate to a competitors using the same criteria only to find out that both products produce the same results in ACDF's? To paraphrase one of our surgeon readers, "Iz it the Plate or the Playa?" Rarely, if ever, does the surgeon- author(s) ever criticize the product's efficacy or design, why would they, if the study is funded vis-a-vis a grant by the company itself? Isn't that why products are named in studies in order to promote a companies product? Yet, this article raises a bigger question. Is this an assault on the integrity of the medical profession? Today, spine surgeons complain that they do not earn as much money as they had in the past, yet, with the advent of sham consulting agreements, sham royalty agreements, and the proliferation and commoditization of the spine market TSB would argue that there are many more opportunities for greater earnings than ever before.

But what about the publisher? How entertaining is it when Robert Dekker, director of communications for Wolters Kluwer Health/Lippincott Williams & Wilkins is quoted as saying that "all manuscripts go through a rigorous review process using reviewers who have an objective viewpoint." Objectivity is in the eye of the beholder. Is there any surgeon at JSDT that would question the commercial aspect of the white paper? How many of these reviewers have their own consulting agreements? Obviously Dekker declined to provide a list of reviewers. The reader has to laugh at the level of transparency at WKH/LWW. TSB thought the whole purpose of a white paper was to provide the company clinical/commercial visibility? Dekker claims that coverage given to Medtronic products is in no way tied to their relationship with Zdeblick. As Scrooge once said, Bah humbug. Where does Mr. Dekker think his advertising revenue comes from?

If Senators Grassley and Kohler are really serious about enacting the Physicians Payment Sunshine Act of 2009 one of the guidelines should be that spine surgeons be required to wear the logo of the company that they represent on their lab coats in their office and have a promotional billboard in the waiting room for patients and sales people. Considering that surgeons have become personal spokespeople for companies, this really isn't a bad idea. Think of how much more efficient this would make the salespersons life. No more cold calls, no more free lunches, more focus and better time management. Maybe its time that patients have the right to choose the product that they would like the surgeon to implant considering it is their body? In the end, nothing has really changed, and like TSB said old news, is well, old news. You know what Sonny and Cher once sang, "And the beat goes on, And the beat goes on..........drums keep pounding the rhythym to my brain, la de da de de, la de da de da."


  1. "wear the logo of the company that they represent on their lab coats...and have a promotional billboard in the waiting room"

    Nice. But some of the lab coats will be lacking any white space.

  2. Unfortunately i think this post does a diservice to innovation. Dr's are the proper individuals to invent products. Not scientists or engineers.

    Engineers goals are not to minimize pain but to construct a device with input from someone that can be manufactured. Examples of engineered products with minimal Dr input include the TOPs system. This is a generality as some engineers with years of experience are excellent but my experience has been that the best engineers are the ones who mention a dr's name 20 times through a conversation.

    Scientists in my opinion are worse if acting alone. Instead of a long diatrabe i will leave it with this. ICRC - cartilage repair society - their clinical scoring system contains NO scoring for pain reduction. only for cartilage amounts, quality, etc. Leave a scientist alone with the wrong business people and you get nucleur bombs. I know - very mean but trying to make a point. Again a generality as many scientists are first in class.

    Obviously all should be involved but a Dr. in my opinion is the most important component. To service the reduction of pain in the human body via surgery it is imperative that the ones who work in the body are the focal point --- the eyes of the idea. Not the last check off.

    With all this being said posts like this give the feeling that Dr's making money off the invention of products is a disservice. And if you agree then think about the waterfall of steps thereafter.

    Invention - Dr. Idea

    Ownership and financial award. - Shouldnt a dr. receive benefit. Only the business guy who backs him financially?! Of course not. Especially if you live in the USA

    Dr.'s Bias towards his own invention - If a Dr. invents a product doesnt that usually mean he thinks his idea is better? If standard of care technologies have 5 to 10 to 20 year survivial rates doesnt that mean the inventing dr. may not know if his idea is or is not the best idea for decades? Doesnt that mean he has a scientific and a moral right to believe he has the best technology if the laws of the land allow for it to be implanted?

    Clinical Studies - Have you ever tried to get a new doctor to try something where the inventing doctor never used or studied it? A 2nd doctor is gonna be the first to use? How about if the inventing dr. tries it, doesnt have clinical proof on paper and tells Dr. #2 "i invented it, used it, its unbelievable, but no.....i dont have any documented proof". Please think about this.

    I am not absolving Zdeblick as I dont have all the facts and unfortunately todays world is too complex to easily explain everything. I understand the normal us citizen finds it incredible that a doctor gets paid for his own products. i know i did when i began in this industry when i thought more like a normal us citizen than a orthopedic industry individual. But the fact of the matter is if you believe the above and you live in a capitalist society it most certainly is the proper and just course.

  3. As usual Home thank you for your commentary, unfortunately, you really did not read what I said, "TSB has no problem with Zdeblick getting paid for products he truly developed." TSB and our readers have a problem that a conflict of interest could potentially exist when Zdeblick is the editor-in chief of a clinical publication that endorses a product that he can benefit from financially. The question to you is where do we draw the line? It's not about capitalism, its about ethics and greed.

  4. To the person identified as Home did you read the same blog that I did. TSB never said anything about Zdeblick not having the right to be paid his royalties, I guess you don't see the conflict.

  5. I see the conflict. But i see it as a byproduct of my earlier post. The best, most experienced surgeons SHOULD be the editors. They will also be the ones that SHOULD invent products. Of course there will be a conflict and there should be. Its how the conflicts are dealt with which is what matters.