As we've discussed at length this week, we are no longer in the "old days" of consulting, when many backdoor bribes and rewards were given for simply cooperating with a provider. As a result, a conflict of interest forms, and the physician becomes greedy as they reap the benefits.
When physicians limit themselves to one or several products from specific providers, they may become hesitant to adopt better technologies to maintain the rewards they receive from those clients. Unfortunately, that would mean they didn't serve the best interests of their patients, risking their health and decreasing their quality of life.
Dr. Simon provided several common scenarios, ranging from offering sponsored vacations, unrestricted research grants, luxurious dinners, and effortless consulting agreements. But, what are specific, notorious examples that might've led to the creation of Advamed & DOJ-enforced guidelines and laws/statutes? Have any of you even experienced a remnant of this personally as a professional or patient?
With those specific events, do you believe the mentality behind this can be fully remediated, or can we never "rely on physicians to be the adult in the room?"
The AdvaMed and DOJ oversight has become so strict since scandals have become large-scale and public. One example is the 2007 orthopedic device kickback scandal. In this scandal, major companies like Zimmer, DePuy, and Biomet were investigated for paying surgeons millions of dollars in “consulting fees” that did not have any real deliverables. The fines that the companies had to pay added up to $310 million. Biomet Orthopedics was fined “$26.9 million,” “DePuy Orthopaedics was fined “$84.7 million,” and many other companies were fined (Feder, 2007). Healthcare decisions were found to be made on the doctor’s wallet instead of patients’ well-being, and this was a huge cause for AdvaMed and the DOJ to increase their restrictions. This showed how “consulting” had become a marketing channel instead of an actual expertise-driven collaboration for the betterment of the community.
The structural incentives reward loyalty over clinical objectivity. With an income tied to purchasing volume, human psychology takes over, and people become greedy and money-driven. The physicians with the best intentions can fall victim to reciprocity bias and try to give back to the medical device company, relationship bias, and other pressures. This led the old system to collapse. To answer the question regarding whether the mentality can be fully remediated, I do not think it is a question as simple as making the physician be the “adult in the room.” Highly ethical people can still be influenced by systems that highly reward bad incentives. I think making the system itself less temptation-based and more regulated with documentation and liability would reduce fraud in and of itself.
The architecture of the system matters the most, as putting up barriers would allow being the “adult in the room” to be much easier and rewarding. AdvaMed and the DOJ have already started doing this with the new system. Do you think the industry should go even further? Do you think they should ban all paid interactions between physicians and device companies, or would this hurt legitimate innovation? Where should the line realistically be drawn? Can AI play a role in ensuring corruption is not rampant?
Feder, B. J. (2007, September 28). Artificial-Joint Makers Settle Kickback Case. The New York Times. https://www.nytimes.com/2007/09/28/business/28devices.html
Several high-profile scandals in the 1990s and 2000s directly shaped today’s AdvaMed and DOJ-enforced compliance rules, most notably the 2007 orthopedic device investigation in which major companies paid surgeons sham consulting fees, luxurious travel, and research “grants” tied to product use; extensive spine-surgery kickback schemes involving Medtronic that relied on paid speaking roles, ghostwritten research, and lavish perks; cardiac-stent overuse cases where financial relationships drove unnecessary procedures; and multiple device and pharmaceutical settlements involving extravagant dinners, resort conferences, and advisory boards used as loyalty programs rather than genuine scientific exchange. These incidents demonstrated how easily financial incentives could distort clinical judgment, erode patient trust, and compromise outcomes, prompting federal oversight, corporate integrity agreements, and industry codes intended to rebuild ethical boundaries. Although these reforms have significantly reduced overt abuses, remnants of the mentality persist—now in more subtle forms such as aggressive “education” dinners or disproportionate vendor loyalty—and complete eradication is unlikely because strong commercial incentives, information asymmetry, and the inherent complexity of physician–industry collaboration mean that oversight will always be necessary; relying solely on physicians to self-police ignores human behavior and the structural pressures that helped create the problem in the first place.
