Although considerable attention has been devoted to the relationships between physicians and pharmaceutical companies, relatively little attention has gone to the relationships between physicians and device companies. The device industry is especially significant given its size, growth and the amount paid to physicians.
Moreover, although interactions between physicians and the medical device industry present many of the same conflicts of interest as interactions with the drug industry, there are very unique aspects to devices.
1) Financial relationships between physicians and the device industry are such that attempts to establish a “device formulary” paralleling efforts regarding a drug formulary do not often succeed.
2) Unlike drug reps, it is no simple matter to ban device reps. They are considered helpful, even at times essential, in training physicians to use devices; it is not uncommon to find them in the operating room acting as a member of the surgical team.
3) Company payments are large and can exceed $1 million to an individual physician in a single year.
4) Device companies may pay substantial royalties not only to physician-inventors but also to their institutions. Managing the conflict of interest, then, raises thorny questions about institutional conflict of interest.
Our research into devices and conflict of interest is being facilitated by the fact that company relationships to medicine have come under governmental scrutiny. As part of a settlement five orthopedic device companies are disclosing payments to physicians. This data offers an unusual opportunity to investigate professional norms and physician relationships with industry.