Saturday, February 15, 2014

"You're Another" Should Be an Admission of Guilt

Charles Ornstein, investigative reporter at ProPublica, recently commented on a flap involving (to put it bluntly) university docs shilling for a device company:

He cited a blog by Paul Levy, a former CEO of New England Deaconess Medical Center in Boston. Levy noted an ad for the da Vinci surgical robot that featured a group photo of surgeons from the University of Illinois (Chicago) Hospital. Mr. Levy did a little digging around and discovered that such an appearance in an ad seemed to violate U-Ill. official policy. So he sounded off in several blog posts and the University eventually took note and said they'd look into the matter, while insisting that these surgeons did all this out of the kindness of their hearts and were not paid for appearing in the ad.

You might wonder why the flap over a surgical robot. These devices can cost a cool $2M or more each, and of course when introduced were touted as the greatest new medical breakthrough. Sadly, to the extent that evidence is becoming available (and I admit I have not followed this debate as closely as one might), the bulk of data seem to question whether robotic surgery produces outcomes that are superior to the old garden variety surgery, and indeed in some cases there may be worse complications--leading for instance the American College of Obstetrics and Gynecology (ACOG) to state (as Ornstein noted) that robotic hysterectomy has not even been shown to be as good as, much less better than, the old-fashioned and vastly cheaper procedure.

This has left a lot of hospitals, who rushed to obtain "the latest" out of fear that both their surgeons and their patients would desert them for the "better" hospital up the street, with expensive robots that now threaten to become white elephants. So you can see why the maker of the robot would want to run ads reassuring everyone that these devices are indeed worth their weight in gold.

What I wanted to comment on regarding this incident are two things.

First: Intuitive, the company that makes the robot in the ad, responded to the discussion by saying: "In the past year, there has been much misinformation about robotic-assisted surgery, spread largely by plaintiffs’ lawyers as well as segments of the health-care community threatened by our groundbreaking technology. ...  The University of Illinois, which uses our technology, and the people featured in the advertisement agreed to appear without compensation. Those who use our technology see first-hand the outcomes resulting from its use. Their unpaid testimonials of da Vinci surgery are credible and sincere."

So, first, only evil folks with an axe to grind say anything bad about robotic surgery (take that, ACOG); and second, no one paid these nice Illinois surgeons a dime to be in the ad. Now that latter may be true; I can't disprove it. But knowing what we know about both the largesse of device makers toward docile docs who tout their wares, and the extent the makers sometimes go to to launder the money as it changes hands, I'd frankly be quite surprised if there's no quid pro quo someplace.

Second: Ornstein spoke with Thomas Hardy, executive director of university relations at U-Ill. Chicago. Mr. Hardy wanted to be sure that Ornstein knew all about a shady event in blogger Levy's past, which if you want to read the dirt, is detailed here:

So Ornstein asked Mr. Hardy exactly how this previous, and admitted lapse of Mr. Levy was relevant to the discussion of the ad with the U-Ill. surgeons that appears to violate U-Ill. official policy. Hardy's reply was: “I believe if you’re attributing claims and accusations to the blogster, your readers deserve to know his reported background so they can make an informed decision about his credibility…Wanted to make sure you have the pertinent information.”

Right. So know we know what sort of person we're dealing with.

I have a proposal for a new rule: If a person accuses you of conflict of interest or a similar lapse of professional responsibility, and the best defense you can come up with is an ad hominem attack against the person regarding something that's irrelevant to the present controversy, then your ad-hominem attack ought to be viewed as in itself an admission of wrongdoing.

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