Feb. 10: This article has been corrected.
Flipping through the New York Times
magazine a few Sundays ago, former hospital executive Paul Levy was taken aback
by a full-page ad for the da Vinci robot.
It wasn’t that Levy hadn’t seen
advertising before for the robot, which is used for minimally invasive
surgeries. It was that the ad prominently featured a dozen members of the surgery
team at the University of Illinois Hospital and Health Sciences System. “We
believe in da Vinci surgery because our patients benefit,” read the ad’s
headline.
“While I have become accustomed to the
many da Vinci ads, I was struck by the idea that a major university health
system had apparently made a business judgment that it was worthwhile to
advertise outside of its territory, in a national ad in the New York Times,” Levy,
former chief executive of the prestigious Beth Israel Deaconess Medical Center
in Boston, told me by email.
As Levy scanned the ad further, he
noticed that at the bottom the ad bore a copyright for Intuitive Surgical Inc.,
the maker of the da Vinci system. It included this line: “Some surgeons who
appear in this ad have received compensation from the company for providing
educational services to other surgeons and patients.”
Ads for prescription drugs and medical
devices are common, and some feature physician testimonials about why they
believe the product works. Physicians also deliver promotional talks for drug
and device makers, something we’ve covered extensively in our Dollars
for Docs series.
But a whole hospital department? Levy
wondered: Was this kosher?
“I was stunned that a public
university would allow its name and reputation to be used in that way,” he
wrote. “The next day, I did a little research on the university’s own website
and confirmed that my initial reaction was correct: The ad violated the
University’s code of conduct and administrative procedures, and likely state
law.”
Da Vinci robotic systems aren’t cheap.
The Wall Street Journal reported last year that they can cost up to $2.2 million each, and questions have been raised about their
value. A study found that deaths and injuries caused by the robots are going underreported
to the U.S. Food and Drug Administration. And the American Congress of
Obstetricians and Gynecologists said in a statement last year: “There is no good data proving that robotic hysterectomy is
even as good as—let alone better—than existing, and far less
costly, minimally invasive alternatives.”
Levy, who runs a blog called Not
Running a Hospital, began writing a
series of posts about the ad. The first, called Time to Fire Somebody, ran on Jan. 22. “The University has allowed
its reputation to be used in a nationally distributed advertisement produced
and owned by a private party, in benefit to that party’s commercial objectives.
This is not consistent with ‘exercising custodial responsibility for University
property and resources,’” it said.
Levy subsequently wrote a post noting that some of those who appeared in white
coats in the ad weren’t doctors; one wasn’t even a medical professional,
instead serving as the administrative director of the University of Illinois at
Chicago Robotic Surgery Training Center, according to her LinkedIn profile.
Levy found that the university’s campus administrative manual appears to prohibit such advertising: “In general, the University cannot permit its
image to be used in any commercial announcement, in a commercial or artistic
production, including the World Wide Web or in any other context where
endorsement of a product, organization, person, or cause is explicitly or
implicitly conveyed,” the manual says.
Subsequent posts focused on the
hospital’s board of trustees, Intuitive’s disappointing earnings, and the compensation received by the dean of the University of Illinois College of
Medicine at Chicago for serving on
the board of directors of drug
maker Novartis. Levy forwarded the posts to the president and trustees of the
university and suggested that they investigate.
Then, one day this month, Levy received an email from Thomas Hardy, the University’s executive
director of university relations. It said the ad was paid for by Intuitive, the
da Vinci maker, and that neither the university nor those pictured were
compensated for appearing in the ad. Nonetheless, Hardy’s note continued,
“We asked Intuitive to suspend the ad, and the
company agreed, immediately upon learning of concerns expressed about it. Our
request was based on a business decision; we were concerned that the ad was not
benefiting UI Health. Out of an abundance of caution, we decided to review
circumstances surrounding the publication of the advertisement. We will
use this opportunity to conduct a methodical assessment of policies,
guidelines, procedures and practices, and where corrective changes are required
we will take the appropriate action.”
The president of the University of Illinois system asked
his vice president for research to investigate the matter and report back
to him by March 15 if policies had been violated.
By writing about the issue, Levy appears to have made
an impact on how the university navigates commercial relationships.
But the
university and Intuitive are not patting Levy on the back.
In response
to questions from me, Hardy reiterated what he had told Levy and also pointed me to a
Boston Globe opinion column that faulted Levy
for lapses in judgment in a personal relationship with a female employee while
he led Beth Israel Deaconess. Levy was fined $50,000 by the hospital’s board of
directors.
When I
asked Hardy how this was relevant, he wrote in an email, “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.”
Levy said
he had admitted his errors
publicly and apologized.
Intuitive
spokeswoman Angela Wonson said in a statement that she believes the ad was
appropriate and that the testimonials from university staff were unpaid.
“Medical
schools and their affiliated hospitals are our customers and play an important
role in training surgeons. In the past year, there has been much misinformation
about robotic-assisted surgery, spread largely by plantiffs’ lawyers as well as
segments of the health-care community threatened by our groundbreaking
technology. Intuitive’s advertising campaign is intended to educate both the
medical and patient communities by using factual information from independent,
peer-reviewed studies that prove the safety of our system. 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.”
Levy first
questioned the value of the da Vinci in a blog
post in 2007, but a year later, he
wrote about how his hospital bought one anyway. “Why?
Well, in simple terms, because virtually all the academic medical centers and
many community hospitals in the Boston area have bought one. Patients who are
otherwise loyal to our hospital and our doctors are transferring their surgical
treatments to other places,” he wrote.
Other
medical device companies also use doctors in their ads and videos. Hologic
Inc., which makes a 3D mammogram machine took out an ad in a trade journal last
year featuring the staff of Methodist Hospitals in Merrillville, Ind. And
Accuray, which makes the CyberKnife, a competitor for the da Vinci system, includes
physician testimonials in videos on its site. One
video features a physician from Beth Israel Deaconess. The videos do not
disclose if the doctors have been paid.
“Accuray
does not typically reimburse physicians to participate in the video
testimonials on the website and they are not considered company spokespeople,”
the company said in a statement. “Some of the physicians and/or their
institutions may have received payment for other activities, such as speaking
at an educational or medical conference, or for conducting research.”
Beth
Israel spokesman Jerry Berger said its doctor, Irving Kaplan, “was approved
under the policy we had in place when the video was shot in 2011. He was not
compensated for the appearance.”
Levy said
he has a financial relationship with EarlySense, which makes equipment to
monitor heart rate, respiration and patient movement. He sits on the company’s
advisory board. It is not a competitor to Intuitive.
