November 03, 2007	Saturday	Shawwal 21, 1428

MINNEAPOLIS: The hips and knees are synthetic, but it is real money that is changing hands.

Five makers of artificial joints have paid more than $200 million (euro139 million) this year to US doctors and hospitals, often the same ones who are deciding which company’s joints to buy, according to an Associated Press calculation of disclosures required this week by a settlement with federal prosecutors.

The five companies were scrutinised by the US attorney’s office in New Jersey over allegations they gave money and trips to surgeons who used their products. Four of them – Biomet Inc., DePuy Orthopaedics Inc., Smith & Nephew Inc. and Zimmer Holdings Inc. – had their charges dropped when they paid a total of $310 million in fines and agreed to monitoring in a settlement announced in September. The fifth company, Stryker Corp., was never charged and paid no fines but agreed to disclose its payments.

The payments to doctors and hospitals ranged from a few dollars to individual doctors to about $3.9 million to Mayo Clinic. And the AP’s calculation is conservative, because the companies were required to disclose payments within a $25,000 range, and the AP used the low end in its calculation.

The money includes items like royalties for inventions and payments for teaching classes. Prosecutors alleged that from at least 2002 through 2006, the companies paid exorbitant amounts for doctors to be consultants and to use their products exclusively.They did not allege that all the money was illegitimate.

“Certainly it was not a majority of doctors who had contracts that were operating illegally,” said Mike Drewniak, a spokesman for the US attorney’s office in New Jersey. Drewniak said the investigation into the five companies in the settlement has wrapped up, but that prosecutors are still looking into payments by smaller medical device companies.

The settlement required the companies to disclose who it paid during 2007, and to update the information quarterly. Later this year, it will also require them to disclose non-monetary payments, such as trips.

Mayo took in money from all the companies except Biomet, including almost $2.1 million from DePuy. Mayo spokesman Lee Aase said nearly all of the money it received was for royalties, as well as sponsored research. Doctors who invent medical devices get paid some of the royalty money through the clinic, he said.

“By lumping all this stuff together, you have some places like Mayo look like one of the bigger recipients of this, but it’s because they’re inventing things,” Aase said.

Zimmer Holdings, the biggest maker of artificial hips and knees, paid the most to doctors – $85.8 million, according to the disclosure made on its website on Wednesday. DePuy paid $48.8 million, Stryker paid $27.8 million, Biomet paid $19.6 million, and Smith & Nephew paid $19.3 million.

DePuy said in a statement that it had begun to change its interactions with doctors before the Justice Department investigation was announced. It said that the payments are “critical to advancing patient care and keeping the orthopaedic community appropriately educated and trained on new products and surgical techniques”.

Spokesmen for Zimmer, Stryker, and Smith & Nephew all declined to comment. Stryker posted its information in a way that made it difficult to sort the data and declined a request to make it available in a more usable format. A Biomet spokeswoman did not return a phone message seeking comment.

Cincinnati orthopedist Dr Edward Lim has written about the relationship between doctors and the implant industry. He also was listed as receiving $14,794 from Zimmer.

He said the money was for teaching classes that demonstrate joint replacements, such as a new shoulder he put into a cadaver last week.—AP