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May 1, 2007
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Christopher Fleming

Consumers Taking Major Role In Decisions About Medical Devices, Says Industry Leader

Stryker Chairman and Former CEO John Brown Also Says Media Have Exaggerated Safety And Conflict-Of- Interest Concerns About Medical Device Industry

Bethesda, MD -- Consumerism is not coming to the orthopedic implant business -- it has already arrived.

So says John Brown, current chairman of the board and past CEO of Stryker Corporation, in an interview published today on the Health Affairs Web site. See: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.3.w436. Stryker makes a diverse line of products including artificial hips and knees and other orthopedic implants, medical instruments, and beds and stretchers. The company also runs more than 400 orthopedic rehabilitation clinics.

“Because of the knowledge gained through the Internet, sophisticated patients and their families know who are the manufacturers, who are the leading surgeons, and they insist on getting the best surgeon and best product,” Brown tells Rob Burns, a professor of health care systems and management at Wharton.

Brown also notes that when Stryker did its first artificial hip direct-to-consumer ads, which featured Jack Nicklaus, the company got “a good bit of feedback that several patients were coming in saying, I want the same thing Jack’s got.” The Nicklaus ads generated “some early criticism,” but “everybody is doing it now. So, we were just the first.”

Quality Matters More Than Price
For Orthopedic Implants, Says Brown

According to Brown, “there have been very few sweeping changes in orthopedic implants,” and the potential for biotechnology to have a “revolutionary” impact on orthopedics “has not yet fully materialized.” However, over the years, “dramatic improvements” in the quality and durability of implants have occurred incrementally, and these improvements ultimately are more important than price considerations, Brown argues: “The thing with implants is that getting a reduction in the price is not nearly as important as being assured that you’ve got something that’s going to last fifteen to twenty years.”

Asked by Burns how to “document quality with implants, when you don’t know the outcomes of the next generation for at least ten years,” Brown acknowledges that “there’s no accepted clinical study that shows that short-term results predict long-term results.” Nevertheless, Brown says, group purchasing organizations have made only “limited” headway in negotiating with device companies on behalf of hospitals because “market share in orthopedic implants just does not shift on the basis of price. It tends to shift on the basis of quality and the characteristics of the product itself.”

Burns asks whether the medical device industry will follow the pharmaceutical industry as “the next big target” of congressional scrutiny. “I would be very surprised if it did,” Brown responds. “I think that the American public feels that technology has been good for them. The average Joe doesn’t complain about the cost of his hip, the cost of his knee, or the cost of his pacemaker or defibrillator. On the other hand, you hear countless complaints that someone just came back from the drugstore and they had to plunk down fifty dollars for their prescription.” Brown adds: “Part of it is that a high-cost device is a one-time incident, whereas pharmaceuticals are recurring, long-term costs.”

Media Overstate Safety,
Conflict-Of-Interest Concerns

Brown calls concerns about safety problems with medical devices “a media-fanned story. Granted, there are product failures; there always have been. But what the media has missed is the number of lives . . . saved.” Brown also suggests that reporters have exaggerated conflict-of-interest concerns caused by ties between surgeons and device makers: “In the device industry, there needs to be ongoing dialogue between physicians and manufacturers to optimize the product, the instruments, and the surgical techniques. Reporters don’t seem to understand this need because it is different than what is required in pharma or other industries, and I believe that their coverage often reflects this lack of understanding.”

Burns asks Brown if he agrees with a proposal, made recently in Health Affairs by Project HOPE senior fellow Gail Wilensky, to establish a national database of comparative data on prices and quality for medical devices. Brown replies: “I’m not going to speak for the industry, but I think that if . . . you’re going to run a national registry on products, then you should also run a national registry on surgeons and the hospitals that provide these services and see what their record is, too.”

You can read Burns’ interview with Brown, the seventh in a series of interviews with leaders of the biomedical sector sponsored by the nonprofit Institute for Health Technology Studies, or InHealth, at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.3.w436


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2007 Project HOPE–The People-to-People Health Foundation, Inc.