02.Conflicts of interest
Consumers told the Senate inquiry they were concerned that “there may have been inducements paid to doctors or hospitals to favour particular prostheses”.
While the Senate committee noted the various codes of conduct that regulate such practice, such as that of the AOA, it also noted that Johnson & Johnson, the makers of the DePuy devices, had to pay high penalties in the US and UK because of improper payments to health care providers.
The Senate inquiry called on the Department of Health and Ageing to “address the issue of inducements paid by pharmaceutical companies and medical device manufacturers to doctors and teaching hospitals”.
The track record of the device chosen by your surgeon is often not clear since prostheses don’t come with consumer information sheets like pharmaceuticals do.
The Consumers Health Forum is calling for “post-market surveillance and a national register for all prostheses so that consumers can be given high quality, independent information before a device is implanted”. If that information had been available to consumers before they were implanted with the failed prostheses, they may have been spared a lot of pain. Problems with the DePuy devices were evident since at least 2007, two years before they were recalled.
How are prostheses selected?
The hip or knee replacement device that’s selected for you may vary depending on the surgeon you use and whether you’re a private or a public patient.
“In the public sector, different hospitals have been able to mandate the use of different prostheses – they might have an agreement with a provider,” says Cindy Shay, group general manager of provider relations at Medibank Private.
Price is a major factor for the public system, says Graham Mercer, president of the AOA. “The difficulty with the public system is that they will look for the cheapest possible prosthesis.”
If you’re a private patient, your surgeon may have greater choice of prostheses. However, your surgeon’s experience with different devices can limit the choice. Some consumers who were implanted with the failed DePuy devices asked their surgeon for a specific hip replacement device but were not given their choice.