The Health Care-industrial Complex

In his 1961 farewell address, President Dwight D. Eisenhower warned us to “Beware the military-industrial complex.” This term, written by the President's speechwriter, Malcolm Moos, has many parallels in history. The crux of the matter is that, as a society develops, a complex and variable relationship between suppliers and consumers will also evolve.Today we are hearing talk of a health care-industrial complex. A leading story of the moment is Iowa's United States Senator Grassley, a prominent figure in health care reform, proposing more sunshine and disclosure of physicians' financial relationships with health care industries.Currently, the Senator sent a letter to about 30 institutions which included my alma mater, The University of Minnesota. The letter cited a spine surgeon faculty member and his consulting fees from a locally based medical device firm, which are said to total $1.2 million for the period 2003–2007. Even more surprising was the comment from one expert who called the amount high, but not an “order of magnitude different than what a lot of doctors are getting.”1Other recent headlines: Professor at Canada's McGill University Admits Signing Research Generated by Drug Maker.2 Surgeon who led tainted study is leaving his job (at Washington University in St. Louis).3 Medical schools and drug companies too cozy.4 All of this appeared in the national media in just a few days!Are we on this kind of slippery slope? Is there reason for concern in orthodontics? Of course our industrial-orthodontic relationships have changed over time. Many orthodontic suppliers have merged with very large conglomerates. Often the orthodontic component of these conglomerates is a relatively small component of the corporation. A conglomerate may operate under the reasonable assumption that business is business and health care will respond to the same marketing techniques that work everywhere else.At our end the corporate contribution to meetings is the financial backbone of our national and many other meetings. Many meetings have evolved to where corporate backing is almost indispensible. Still, it is critical to remember that the ultimate goal of a corporation is profits and that is very appropriate. However, at the same time our primary goal is care of the patient and the potential for these two varied interests to come into conflict is always present.We are all aware of the orthodontists who speak under the aegis of a corporation at our annual meeting and elsewhere. The risk is always present for the corporate personnel to want to edit professional presentations to insure that the company's products are represented only in the best possible light. This is only one existing example of an area of a potential conflict of interest.How does Senator Grassley propose to address the conflict of interest question? He is proposing an act entitled the Physician Payments Sunshine Act to make doctor-industry ties more transparent. This would bring more sunshine to the current faculty industrial relationships. It apparently would work through the Physician-University ties. Certainly we would benefit greatly from increased sunshine in such relationships in orthodontics. Perhaps sunshine would act as a preventative action and avoid getting caught in situations analogous to those currently before us.The principle of increased sunshine appears to be the only practical approach put forward thus far. Physicians have traditionally been overseen by hospital affiliations. Orthodontics, as a cottage industry, has had few such relationships. The area of the health care industrial complex is outside the realm of the state boards. The only apparently common denominator in orthodontics might be our professional organization, but this question is outside of their realm also.None of us, including the industrial interests, want some political body to see a need to act in the interest of protecting the public. Let's act to find a reasonable way to deal with this potentially hot button issue ourselves so that we may pass a clean torch to future orthodontists. In the words of Albert Einstein, “It is every man's duty to put back into the world at least the equivalent of what he takes out of it” and we have all been richly gifted.

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