October 22, 2020

Sales Tactics on Implants Raise Doubts

To compete, “we must be able to ‘answer the bell,’ ” wrote Thomas V. Brown, an executive vice president at the American subsidiary of Biotronik, a small German firm that makes pacemakers and defibrillators.

Mr. Brown’s charge came in an e-mail last year to fellow Biotronik executives, one of scores of documents involving the company that offer a portrait of an implant industry where producers seek to influence the brand of device that patients receive long before a diagnosis.

The documents show, for example, that device makers recruit not only implant specialists as consultants but also general cardiologists who refer patients. Those cardiologists, called feeders in one of the documents, can benefit by enrolling the referred patients in a company-financed study that can pay a cardiologist up to $4,800 a patient.

A lawyer representing Biotronik, Christopher Myers, said Mr. Brown’s e-mail was sent around the same time that some Biotronik sales officials were asking the company to design “unscientific studies” to compete with producers offering sham studies “as a means of funneling money to doctors.” Mr. Myers said Biotronik executives like Mr. Brown had refused to do so and that the company’s studies were all scientifically sound.

In recent years, big makers of implants like heart devices and artificial joints, including Johnson Johnson, Boston Scientific and St. Jude Medical, have settled Justice Department charges that they illegally promoted sales. The enforcement effort has sought to reduce the role of corporate influence over medicine through tactics like bogus or inflated consulting deals with doctors.

Since last year, the Justice Department has been investigating Biotronik’s sales and marketing practices. Biotronik and its consultants have not been accused of wrongdoing, and Mr. Myers said the company had abided by all federal regulations. Citing the Justice Department investigation, executives of the company’s American subsidiary, which is based in Lake Oswego, Ore., declined to be interviewed.

“The implication that our contractual partnership with expert cardiologists is simply to enhance sales is flatly wrong and unfair,” the company stated in a recent news release.

However, sales tactics, rather that scientific data, can determine which company’s device a patient gets because doctors have no independent source of information about which implants work best or last longest, several experts said.

“There is no reliable way to compare different devices on an independent basis,” said Dr. Alan H. Kadish, a cardiologist who is the president of Touro College in Manhattan.

The Biotronik documents, which discuss the company’s sales tactics and those of some competitors, were provided to The New York Times earlier this year by a former Biotronik employee involved in an employment dispute with the company. Biotronik said that last year it had fired the employee, Max Bennett, for inappropriate behavior; Mr. Bennett said that he had been fired after he complained to company executives about corporate wrongdoing.

The lawyer for Biotronik, Mr. Myers, described the records as providing a limited and misleading view of the company’s operations.

In the last few years, Biotronik’s share of the market has grown to about 5 percent from 1 percent, according to a recent report by Matthew J. Dodds, an industry analyst with Citi Investment. The company has attributed the increase to, among other things, products that it says are better and more reliable than those of competitors and to better service to doctors.

The documents, which include e-mails, sales reports and strategy documents, offer another possible contributing explanation: the company’s success in developing relationships with doctors who, in turn, can influence which brand of device a patient gets.

The company’s relationship with a general cardiologist in Tucson, Dr. Monty C. Morales, is the subject of several memos.

Article source: http://feeds.nytimes.com/click.phdo?i=b6f20eb5f71459827d57b903b23e6be6

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