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[whitespace] E is for Ethicon

When it comes to corporate sponsorship, Stanford Medical Center and its embattled doctors have discovered the ties that bind

By Mary Spicuzza

HISTORICALLY, the Nezhats have become much more accustomed to fawning praise than criticism. They were lauded by TIME magazine in the mid-'80s as pioneers in the burgeoning field of laparoscopy. At that time the brothers started getting attention from other national magazines, news stations and daytime television talk shows. They have a personal website--www.nezhat.com, which now advertises their upcoming training workshop at Stanford--and serve as advisers for numerous journals and organizations, including the Endometriosis Association. Peers have also been quick to offer praise.

"Just as in Star Trek, he dared to go where no man went before, and by doing this, he opened up unimagined vistas to endoscopic surgeons all over the world," Dr. Alan DeCherney, a professor of ob/gyn at UCLA, wrote in a 1995 foreword to one of the Nezhats' two popular textbooks.

The Nezhats have had 22 surgical devices named after them--equipment like the Nezhat-Dorsey Hydro-Dissection Streamline Pump, available through Davol Company, and the Nezhat-Coherent Laparoscopic Coupler, sold by Santa Clara-based Coherent Inc. The Nezhats also helped found American Hydro-Surgical Instruments with James Dorsey, which in 1995 sold $20 million worth of medical equipment.

Shortly after arriving at Stanford in 1993, Camran Nezhat became director of the new Stanford Endoscopy Center for Training and Technology (SECTT) in 1995. Stanford press releases say the center was created in 1994, but spokesperson Ruthann Richter says it was built before the Nezhats arrived at Stanford, in 1992. Camran Nezhat has been criticized for his close ties to surgical instrument companies, but few realize the center that he directs also has such close ties to industry, particularly Ethicon Endo-Surgery Inc., a division of Johnson & Johnson.

"The Stanford center is funded by Ethicon Endo-Surgery Inc., of Cincinnati, which also works in concert with surgeons to develop better endoscopic tools," reads one Stanford Online News Report (issue of April 16, 1997).

According to the report, the center trains 400 surgeons each year in "minimal access techniques" such as laparoscopy. A May 1997 Medical Staff Update from Stanford adds that Ethicon also funds several of those workshops. "The Center, under an educational grant from Ethicon Endo-Surgery Inc. of Cincinnati, currently sponsors five CME-approved courses annually in laparoscopic gynecology annually," the update reads.

Ryan Rhodes, the center's clinical education specialist, previously worked in sales and marketing for industry, "including manufacturers of medical equipment."

The Nezhats have not worked exclusively with Ethicon, and Camran says he doesn't receive any more funding from the company than most surgeons.

"My relationship with Ethicon, it has not been any different than any other surgeon; they haven't given me beaucoups and beaucoups of money," Camran Nezhat says. "I am teaching and they have donated to the university as a nonbinding educational grant and I have nothing to do with it."

He smiles, "When I came to this country, I thought it was an honor that they put your name on an instrument. I should have been smarter! I should have told them to give me royalties."

Ethicon, which retained Nezhat as a surgical investigator, agreed to provide a $125,000 annual educational grant to the new high-tech facility, according to the San Francisco Chronicle (April 15, 2000).

But attorney Jim Neal argues that Nezhat has benefited in numerous ways, including prestige. He cites a 1992 press release sent out by Johnson & Johnson, Ethicon's parent company, proudly publicizing the reported success of the Nezhats' bowel procedures.

"For the estimated 185,000 women who suffer from endometriosis of the rectum, this new advance provides them with relief from the digestive symptoms," reads the Johnson & Johnson press release.

Other doctors find these close ties between surgeons and industry to be worrisome. Dr. Morris Wortman, a gynecologist based in Rochester, N.Y., says that often unknowing surgeons are sold products at industry-sponsored workshops, where prominent surgeons push products made by the company paying them to speak.

"It makes for great video, you can show your patients how good it looks," Wortman says. "Everybody's happy. Except for one problem--it's all based on lies. Those people [doctors] who flip the slides at the podium have unregulated power." He adds, "Industry money buys influence. And a scientific meeting is turned into a surgeons' sales meeting."

If Stanford thought it was in hot water over its ties to Nike, which leaves every school athlete sporting the Nike "swoosh," the stakes are considerably higher in the ob/gyn department.

Dr. Mary Lake Polan, the person credited as helping to bring the Nezhats to Stanford, is now under fire for a study praising ArginMax, a women's sexual dysfunction pill produced by Mountain View's Daily Wellness Company, where she serves as a medical director.

Polan was not available for comment, but her Miami Beach-based public relations spokesperson, Margie Adelman, says she merely works as one of many consultants for the firm.

"Stanford has a long history of being more entrepreneurial," Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, says. "It has more ties to private industry than most."

Ruthann Richter, associate director of Stanford Medical Center's public affairs office, said she didn't know how much total funding or equipment Ethicon has provided to Stanford--and that none of the departments give out information about their budgets.

But industry is willing to talk money when it comes to market trends.

"In the U.S., over 11.7 million women annually seek medical attention for fibroids, polyps and abnormal uterine bleeding. What's more staggering is that it only represents 25 percent of the 46 million women who suffer from these conditions every year," writes Frost & Sullivan on OBGYN.net, later adding, "The overall market is forecast to reach $1.08 billion in 1998, and steadily climb to reach $1.27 billion in 2003."

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From the July 5-11, 2001 issue of Metro, Silicon Valley's Weekly Newspaper.

Copyright © 2001 Metro Publishing Inc. Metroactive is affiliated with the Boulevards Network.

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