The Washington Post reported in this article that medical sales representatives have become a commonality in operating rooms. The article states, "At a time when Washington is trying to find new economies in health care, salesmen in the operating room serve as simple reminders that medicine is a business, with all the potential that entails to promote efficiency, boost sales and extract profit." The companies develop new medical devices and then train their sales representatives on how to use the product. Then the representative instructs the surgeon on how to use the device and even coaches him or her through the surgery. "Many medical devices could not be used — or used safely — without sales reps, said David Nexon, senior executive vice president of the Advanced Medical Technology Association, an industry group," the article says.
Others, such as Richmond gynecologist Catherine A. Matthews, are startled by such an argument, due to the fact that sales reps are primarily interested in selling their product, rather than promoting the best interests of the patient. The doctor-salesman relationship is somewhat disturbing. While some representatives feel they are doing good by quickly providing medical devices to help the patients, others are clearly motivated by the profit involved. Salesman Jim Rogers founded the American Institute of Medical Sales, a school to train people to be salesmen in operating rooms. "The curriculum at the institute ranges from how to perform a joint replacement to how to get inside a surgical suite without an invitation." The institute also provides tips, like reading doctors’ and surgeons’ articles in medical journals and to learn their hobbies, in order to spark conversation and start a good relationship. In other words, in order to gain their favor.
One company that uses operating room sales reps to promote its product is Kyphon. The company sells the Kyphon balloon tamp, used in Kyphoplasty, a new approach to vertobroplasty. Both surgeries operate on the vertebrae and are used on patients with osteoporosis. Internal documents from the company’s reps reveal representatives’ strategies and personal goals, such as forming a strong personal relationship with a doctor that included regular dinners, resulting in more surgeries. Other rep desired for surgeons to operate on more vertebrae in one surgery in order to reach a goal of 100K per month. A third lamented that operations were getting postponed and the patients’ symptoms were going away, resulting in cancellation of the surgery.
Another Kyphon sales representative, Chuck Bates, was urged by the company to tell doctors that if they admitted patients overnight for Kyphoplasty, they would get more money from Medicare than if they did the procedure as outpatient surgery. This allowed the hospital to make more of a profit off of the pricey procedure, and helped Kyphon from loosing business. Bates felt the policy was unethical and joined another sales rep, Craig Patrick, in a whistleblower suit against Kyphon. The company denied that they had done anything wrong, but ended up paying the government $75 million.
There is clearly a strong bond between medical professionals and sales representatives and hopefully new healthcare legislation will weaken the bond.
I find it interesting that this information is just now being written about. Years ago, when handling the Sulzer hip implant litigation I became aware of medical sales reps actually attending and instructing physicians in the implantation of devices. Currently, I know several individuals who are medical device sales reps and they tell me that they routinely attend surgeries and instruct physicians. Keep in mind these reps have no medical degrees or training.