Academic OB/GYN

Today I sat in the infection control committee at Grady Memorial hospital and listened to two sales pitches for products meant to decrease surgical site infection.  I am a tough sell at these meetings.  Some might even say that I am the asshole in the room.  But really the issue is that I say what everyone else is thinking but are too polite to say.

The first pitch was from Ethicon, who was marketing their antimicrobial impregnated suture.   The presentation shows convincing evidence that the suture, placed in a petri dish surrounded by bacteria, does in fact inhibit bacterial growth.   There were many claims made that it also decreased the rates of wound infections in comparison to using typical suture.  When I questioned what data there were to suggest this, I was told that the data was all in my handouts.

I looked down at my handouts and found no data whatsoever.  I found a bibliography of about thirty articles that investigated the product.  I pointed out that there is no data, just a list of articles.  I was reassured that these data support everything that they are saying.
At this point I was kind of pissed.

“So basically you want me to do your work for you?  You are coming here to convince me to convert from non-antibiotic suture to more expensive antibiotic suture on every surgery I do.  If the data clearly support that decision then your sales pitch is easy.  Just describe the data and if its clearly efficacious to do this and the cost is reasonable, then we will switch.  But you aren’t doing that.   You are just telling me your product is good and I should buy it, and then giving me a list of a ton of articles that you claim supports you.  Wouldn’t it have been better for you to come here with a powerpoint that actually described these data, and thus convinced me that what you say is actually true?”   But they didn’t do that.  Instead they just referred to “the data” but never actually said “what the data was”.  In the end they agreed that they would need to have their MSL, or Medical Science Liaison, visit with us to further discuss the data.

MSLs are doctors who work for industry who have the scientific background that sales reps typically lack.  Thus they are good for explaining the science behind a product rather than just repeating a sales pitch.    In this case, given that they were pitching to a room of 20 academic physicians in a infection control committee and trying to land a contract that would represent hundreds of thousands of dollars annually, they should have brought an MSL with them in the first place.

So this afternoon I looked up all the data.  Some of it is supportive of using the suture.  A large number of trials say it does not work.  Several meta-analyses, which combine smaller trials into one big result, do support the use of the suture.   The data was mixed, but infection is a huge concern for us and the suture is only about 10% more expensive than what we use now.  So if Ethicon had just presented that data they might have landed a deal.  But instead they kind of hid the data, and thus left without closing.

The second pitch was from a company that was selling an antibiotic solution used for irrigating surgical wounds prior to closure.  This product was currently being testing in a multi center trial for efficacy.  The rep was trying to sell it as something we should put into use at Grady.

“So basically you are currently running a trial to see if your product works, and you would like us to use it in every patient not knowing the results of that trial?”   Again, I’m the asshole in the room.

“Well we have great data that shows it is non-toxic, so you can only benefit.  And the cost of a wound infection to the system is huge.”

Those kinds of arguments bug me because its trying to play on fear.  He is right that wound infections costs the hospital a lot of money, not to mention the patient who has to deal with it.  But to institute an expensive hospital wide program lacking any data to say that program will work is just wrong.   And once you do it, its very hard to ever roll it back, because it is very hard to ever know if it worked.

It would be great if manufacturers just presented the data, but they never do that.  They spin it, or sometimes they hide the fact there is no data at all.   The sad thing is that I think that at least one of the vendors could have landed a huge contract today if they had just presented like they were talking to a group of intelligent physicians rather than to people who are just going to believe whatever they say.  They just got a lot of questions they couldn’t answer and a room of very unconvinced doctors.

Dr. Fogelson is a gynecologic surgeon and endometriosis specialist who practices at Northwest Endometriosis and Pelvic Surgery in Portland, OR.  Call 503-715-1377 for clinical consultation or email nfogelson@nwendometriosis.com. http://www.nwendometriosis.com