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VA SURGEON SAYS $2.6 MILLION PAYMENT FROM IMPLANT

MAKER NOT CONFLICT OF INTEREST -- "I follow the guidelines

for professionalism provided by the American Academy

of Orthopaedic Surgeons...concerning conflict of

commitment and conflict of interest..."

Story here... http://www.press-citizen.com/ap
ps/pbcs.dll/article?AID=/20071207/NEWS01/712070334/1079

Story below:

-------------------------

UI doctors: Payments no conflict

Four earn more than $2.6M from device-makers

By Kathryn Fiegen
Iowa City Press-Citizen

Four University of Iowa orthopedic surgeons received more than $2.6 million from medical implant manufacturers in 2007, according to recently released data from the companies.

John Callaghan, Richard Johnston, Thomas Brown and Charles Clark were named as physician consultants who received payments from device-makers, according to lists on the companies' Web sites. Of the total, $2.6 million was paid to Callaghan from DePuy Orthopaedics.

Callaghan said in an e-mail to the Press-Citizen that money paid to him from DuPuy came from royalties for hip and knee replacement implants he worked to design starting in 1993.

"I do not receive royalties when I or any other surgeon use these implants at the University of Iowa or the Iowa City Veterans Administration Hospital (VA Central Plains Health Network)," he said in the e-mail. "I follow the guidelines for professionalism provided by the American Academy of Orthopaedic Surgeons and the University policies concerning conflict of commitment and conflict of interest in my relationships with DePuy."

DePuy and four other companies -- Zimmer Holdings, Stryker, Smith & Nephew and Biomet -- were investigated this year by the U.S Justice Department, which alleged they had violated federal anti-kickback laws by paying doctors to use certain products. No charges were filed, according to information from the U.S. Justice Department.

The lists containing physician's names and payouts were released in mid-November but do not specify what doctors were being paid for.

Alongside Callaghan, in 2007: Johnston received $101,897 from Zimmer Holdings; Brown received $20,822 from Smith & Nephew in payments and in-kind sums; and Clark received $21,951 from Zimmer Holdings and Smith & Nephew, including in-kind payments. In-kind payments can include airfare and meals.

Johnston, who retired from seeing patients at University Hospitals, said he was paid for working with Zimmer "years ago" to design a new hip implant. The $101,897 is a royalty payment made to him on an annual basis, he said.

Johnston said there are no ethics violations he is aware of.

"That is not the case here, and I don't know people who have taken money without doing something to deserve it," he said. "The orthopaedic community has nothing to hide."

Charles Clark said he provides feedback and educational expertise to the companies he works with on their implant designs. Clark said he has backgrounds in orthopaedics and biomedical engineering.

"A manufacturer cannot make an implant without such knowledge," he said, adding that he discloses his work with device manufacturers to patients and the university. "All four of us have that expertise from an academic standpoint."

Clark said it also was important to note that surgeons only get royalties on total implant sales from a company minus the amount sold at the hospital they work for, to avoid making money on the number of implants they use from a specific company.

"We do not receive royalties for implants we are involved in designing and are placed at the UI," he said.

Callaghan and Brown did not immediately return messages seeking comment.

According to information on the American Academy of Orthopaedic Surgeons' Web site, many doctors provide valuable services to device manufacturers for payment.

"Many of our AAOS colleagues choose to work in partnership with implant manufacturers to provide consulting advice, conduct research, and educate orthopaedic surgeons and the public," a statement on the site said. "A number of AAOS members are engaged in developing new medical devices to better serve patient needs. The appearance of a physician's name on any disclosure filing referenced above indicates only that he or she has received compensation from the implant manufacturer."

Together, the five companies represent 95 percent of the market in hip and knee surgical implants, according to information from the U.S. Justice Department.

Although the companies didn't admit to any wrongdoing, a settlement was reached this fall and required the companies to regularly update and post consultant lists on their Web sites, according deferred prosecution agreements also posted on their Web sites. The five manufacturers must have federal monitors watch over all consulting agreements signed for the next 18 months.

The lists showed that the University of Iowa also got $8,083 from Smith & Nephew.

University of Iowa spokesman Steve Parrott said the issue recently has come to UI's attention and the administration is "in conversations with faculty members."

"We just haven't had a chance to talk about it yet," he said, adding that he had no information about new policies, the university's payment from Smith & Nephew, if the named doctors were getting paid for legitimate services and if they disclosed their affiliation with the companies to UI.

The university's existing ethics policy states: "Outside professional activities are a normal expectation of employees at a research university provided they do not create a conflict of commitment. Many of these activities generally do not require a written disclosure because they are expected to enhance and not interfere with University obligations. However, if the activities do create a conflict of commitment, written disclosure is required."

Under the policy: "University employees must disclose for review and management outside activities, paid or unpaid, that involve a commitment of time that may interfere with the performance of their University obligations."

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Larry Scott  --

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