"The conflict of interest for physicians in the device world is even worse than in the pharma world," he says. "They promote them, get royalties from them and become advocates for these devices that they're involved with and earn equity from. In the orthopedic world, they're out there writing guidelines when they actually own equity in the devices they're recommending their colleagues use," Nissen tells me.
Nissen says the problem is especially acute in his own field of cardiology, which is why he got involved. "A single group of cardiologists dominate device-related research, and it's an enormous problem in orthopedics where there are so many entrepreneurs and investors," he says.
Other surgeons and interventionalists flock to use them without thinking about how new they are. "It's imprudent. Instead of looking at these devices as unproven, they flock to them as the 'latest and greatest,' when the devices that have a long-term track record might be a better choice."
Nissen says hospitals share some blame as well because they stock the devices that doctors want. "It's harder to put the blame on them, but they certainly should be asking more questions."
Healthcare reform may help mitigate the problem, because it is putting the squeeze on hospitals to reduce costs. That may result in hospitals buying fewer brands that are older and more "tried and true," enabling them to get volume discounts rather than purchasing dozens of brands to meet each physician's preference.