The relationship between the surgery departments and industry has always been quite odd. Part of the tension underlying this arises because industry are interested in establishing relationships with individuals and groups and this sometimes conflicts with procedures and tendering processes of the organization. In the UK we have a Nationally funded Health Service the NHS. There are a great many reasons why the NHS is the envy of many other healthcare systems but sometimes our system which is devoted to ensuring equity of access, fairness and justice may just miss a trick by restricting interaction with industry.
Lets look at surgery as an example. It has not escaped the attention of industry that there are surgery centres that lead and there are those that follow. These indicator centres that lead development often have a high academic profile, a frequent presence in meetings and in journal publications and could be said to shape the way surgery develops locally and also on a national or international stage. The hospital I work in is a good example. Our general surgery department is high volume in every dimension of surgical activity. We publish dozens of journal articles each year and members of our department attend a broad range of surgery meetings as delegates, presenters, and chairmen. There is no question that we have big footprint. A large number of other hospitals regularly feed patients into our specialty services and have trainees coming into our department to learn surgery. It is no wonder then that industry are keen to form relationships with units like ours and the same could be said for many other surgery units. So why are industry interested and what could we bring to industry?
Product development refinement
Surgery uses technology and technology is developed by industry. Innovation in technology finds its way to operating theatres and anaesthetic rooms and it is important that surgeons are involved in product development. How are the designers supposed to know the best way to make things how we want them, if we don’t tell them and give them feedback?
From the industry perspective, products are more likely to gain wider acceptance by surgeons if surgeons have been involved in troubleshooting, design and development of the product.
Some new technologies require to be tested and indicator centres have a key role in this because of their reputation giving credibility to the trial, but also because other follower centres are more likely to want to join in trials where an indicator centre is involved. Public sector organisations usually have the infrastructure that permits clinical trials to be run and the objectivity to run such trials without fear of criticism over commercial conflict of interest that would be raised if industry was directly running a trial.
Groups that present clinical research and show videos of their procedures and techniques can create a brand awareness at a number of levels. Firstly there is the awareness that the product can and is being used by a centre with a big reputation in a particular clinical setting. Second there is the brand awareness that a centre with a big reputation is actually using this product or system and presumably favours it for some reason. Finally, why do you think laparoscopic instruments frequently have the maker’s name written down the intra abdominal part of the instrument? Video sessions are a common feature of every surgical meeting and provide a medium for free advertising for industry increasing brand awareness.
Reputational gain is partly around profiling and building confidence in a product. Our product is used by these top surgery teams that everyone knows have a great reputation and people look to emulate these teams. Why do people wear football shirts with David Beckham’s name on the back? Its not only to be part of the tribe that follows his team but also because they admire the individual and his values and want to be like him or associated with him.
Staff experience training
Relationships between surgeons and industry allow individuals from industry to gain first hand experience of surgery and what it involves. This is incredibly valuable experience and is difficult to gain. For a company manufacturing or selling surgical products, to see them being used in real life and understanding the theatre environment and pressures can be an invaluable experience. As a surgeon having a conversation about a product used for example in liver resection is much more productive if the individual has actually seen a case and has some concept of what it really involves.
What do we get in return?
Interaction with industry can be very rewarding. Developing a surgical product or a drug at an early stage can offer academic opportunities and can be really interesting as the (hopefully positive) results of a trial or development come out. There are interesting people who work in business who have very different backgrounds and skill-sets from surgeons and the usual people surgeons meet and this kind of interaction can also be an interesting learning experience. Understanding the drivers for industry is also quite illuminating and instructive.
Managing relationships with industry?
The boundaries of acceptable and unacceptable behaviour on both sides can be easily crossed. If you work in the public sector, it is not a good thing to be thought of by your peers to be in “the pocket” of any company. If you are considered to be so and try and stand up at a meeting and talk about product X, wear a helmet and be prepared to take some flak! On the other side industry occasionally has an unhealthy relationship with individuals or departments and this can impinge on practice and be quite restrictive. The Association of the British Pharmaceutical Industry (APBI) guidelines have sorted out a lot of the questionable behaviour around corporate sponsorship, buying influence and so on. The most important thing to have a healthy relationship with industry is transparency.
Being very clear about
- This is what we will do,
- This is what we won’t do
- This is what we would consider a conflict of interest
are good starting points. If you are entering into a formal arrangement with a company it is helpful to have a memorandum of understanding and this will usually require involvement of your organisation (NHS or University) legal or commercial team.
What’s stopping public sector involvement with industry?
The degree of Calvinism displayed by the NHS does vary around the country. A more open approach to industry from public sector surgery departments would to my mind offer more advantages than disadvantages. Some of the common barriers to this kind of interaction are
- layers of regulation and permission seeking that deter potential interaction between surgeons and industry,
- a lack of resource or know how in public sector R&D departments to enable interactions between surgeons and industry so that a balance is achieved between the organisation getting best value and industry achieving what it wants
- the Public Sector trying to be too greedy and seeing industry as a cash cow.
The way that the public health sector is going in the UK it is likely that there will need to be closer working with industry and this should be sorted out to everyone’s benefit. Realising the potential of the public health sector as a research and development entity and sharing intellectual property and ideas with industry is in my opinion an aspiration we should all hold.
© 2012 SJ Wigmore