I had planned to attend the Collaborative’s discussion on spine and orthopedics for weeks now. To my surprise, the Twin Cities, known for its expertise in cardiac devices like ICDs and pacemakers, is a big player in the $30 billion global business of fixing creaky hips, joints, knees, and spines. I needed a crash course on a growing and increasingly lucrative industry.

I got that and way more from last week’s breakfast gathering at the Metropolitan in Golden Valley. Adding some spice to the event was the recent publication of stories in the Wall Street Journal and the Star Tribune that examined the legal and ethical minefields surrounding payments medical device companies make to spine doctors and surgeons for consulting services.

In the kickoff story to her excellent series “Doctors, devices, and devices,” colleague (and cubicle neighbor) Janet Moore writes those payments may prompt doctors to recommend that company’s product instead of deciding what’s best for the patient, a violation of federal law (not to mention the Hippocratic oath).

Moore’s Exhibit A: Dr. David Polly, a well respected spine surgeon at the University of Minnesota who’s named in a federal whistleblower lawsuit filed in Massachusetts. The lawsuit accused Polly and 111 other leading spine surgeons of allegedly accepting a total of $8 million in unethical and possibly illegal consulting payments in 2006 alone.

According to the lawsuit, Polly received $344,375 in consulting fees from Medtronic Inc. in 2006 and similar amounts in 2004 and 2005.

To my surprise, the Colloborative panel, which included several industry executives, didn’t attack the media, the fashionable strategy of the day. Instead, Marc Swiontkowski, CEO of the TRIA Orthopaedic Center in Bloomington, did the next best thing.

“I blame the lawyers,” he replied.

Specifically, Swiontkowski, a professor of orthopaedic surgery at the U who knows Polly well, laments that Polly was lawyered up and thus not able to tell his side of the story.

“The story came out in piecemeal,” Swiontkowski said. “Polly was unable to say anything. The lawyers seem to control the game.”

Swiontkowski and other panelists say collaboration between doctors and medical device makers is vital to creating breakthrough products. Manufacturers don’t employ doctors on staff so consulting agreements are a necessary arrangement.

“You can’t divorce industry from needing input,” Swiontkowski said. “Industry needs knowledgable, skilled pepople to design products.”

But what the industry does lack is transparency, he said. The U has strict procedures for doctors to disclose their activities and financial ties to outside companies. But much of that information, including dollar amounts, is not public.

The Massachusetts lawsuit is the only reason why we know Medtronic paid $344,000 to Polly in 2006. The U was not particularly helpful.

Moore writes: “The Star Tribune requested from the University of Minnesota the amount medical device companies pay researchers, staff and doctors. But the university refused, saying it is private personnel data that is not public under the Minnesota Data Practices Act. University records that are public reflect only that the portion of Polly’s income from his base university salary was $52,750 last year.”

Polly’s attorney, John Lundquist, wasn’t going to fess up either. (Damn those lawyers!)

“We are not going to comment on the personal finances of any of our clients,” he told the Star Tribune.

But maybe someone should, said Swiontkowski, noting Polly’s compensation can seem “shocking” to people.

“The U’s procedures are done right,” he said. “We knew what [Polly] was doing at Medtronic. The thing that is missing is the dollar amounts. Let’s just get it out there.”

Disclosure can have a powerful effect on public opinion by suggesting people have nothing to hide. I’m not saying doctors are greedy because they take money from medical device companies. It’s ultimately up to the patient to decide whether or not a doctor has his best interests in mind. But to properly make that decision, I would want to know that kind of information. We require that of politicians, why not the guy who is fusing my spine together?

Sen. Chuck Grassley, an Iowa Republican, and Sen. Herb Kohl, a Wisconsin Democrat, have sponsored a bill to open the payments to public scrutiny. Nevada and Massachusetts have already passed similar legislation. Swiontkowski says he is worried that more states will follow suit. Her prefers the federal bill to supersede the states.

The panelists seemed to understand the power of public perception.

“I believe [transparency] is a positive thing,” said Jon Serbousek, president of Biomet Orthopedics. “We need to partner with doctors. These activities must continue for our industry to survive. Transparency will have a leveling effect in the marketplace and help maintain our reputation and integrity. Patients need to know that we are working on their behalf. With these front page articles, people will shun health care when there is great health care to be had.”

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