Newspapers Examine Issues Related To Use of CT Heart Scans, Consulting Payments to Physicians

Two newspapers on Sunday published articles on issues related to the use of CT heart scans and consulting payments to physicians from medical device companies. Summaries appear below.

• CT heart scans: The New York Times examined how more than 1,000 cardiologists and hospitals have installed CT scanners to allow them to have a "new way to look inside patients' arteries" and "provide extra revenue," although "there is scant evidence that the scans benefit most patients." More than 150,000 U.S. residents received CT heart scans last year at a cost of more than $100 million, and use of the scans likely will increase through the next decade. However, CT heart scans "have never been proved in large medical studies to be better than older or cheaper tests" and "expose patients to large doses of radiation" that increases risk for cancer, the Times reports. According to the Times, the case of CT heart scans offers a "sobering reminder of the forces" that make "it difficult to rein in a new technology long enough to determine whether its benefits are worth the costs." Under FDA rules, manufacturers of CT scanners do not have to provide clinical data to prove that their products benefit patients, only that they are safe and can produce accurate images. A "faith in innovation, often driven by financial incentives, encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older techniques," the Times reports. "Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the U.S. spends much more on health care than other industrialized nations," according to the Times (Berenson/Abelson, New York Times, 6/29).
  
  
• Consulting payments: The Philadelphia Inquirer examined how "hip- and knee-replacement surgery has exploded" in the past decade and has "fostered a system of five-, six- and seven-figure payments to doctors in royalties, consulting deals and speaking fees" from medical device companies. Such financial arrangements, "long an open secret in the medical community," recently have "come under intense scrutiny" from federal prosecutors and lawmakers, the Inquirer reports. Federal investigators who have begun to examine the financial arrangements in some cases have found large consulting fees paid to physicians "for little or no work, lavish trips disguised as medical seminars" and "direct payments to surgeons that seemed aimed at convincing them to use a company's product," the Inquirer reports. An Inquirer analysis of disclosure statements posted on medical device company Web sites found that 51 physicians in 2007 received more than $1 million each. Some observers maintain that the financial arrangements create a conflict of interest by "skewing doctors' judgments on how best to treat their patients," but others "concede that payments to pioneering surgeons who help design and patent artificial joints and other medical devices are legitimate," according to the Inquirer (Goldstein, Philadelphia Inquirer, 6/29).