Thomas Zdeblick, a prominent spinal surgeon and orthopedics department chair at the University of Wisconsin-Madison (UW), has received more than $25 million in royalties from device maker, Medtronic, Inc., since 2003. According to a report from the Journal Sentinel, some are now questioning whether Zdeblick can objectively serve as a department chairman at the University.
While receiving his Medtronic royalties, Zdeblick co-authored several positive research papers about the company’s spine products, including its controversial Infuse Bone Growth product. Infuse, made from a genetically engineered material called rhBMP-2 (recombinant human Bone Morphogenetic Protein-2), and is approved for use in one type of spine surgery called anterior approach lumbar fusion. However, it’s frequently used off-label in other spinal procedures. According to the Journal Sentinel, Zdeblick has faced criticism in the past for failing to connect rhBMP-2 with several serious complications in published research.
Another study he co-authored he co-authored in 2003 involving Medtronic’s LT-Cage device, designed to be used with rhBMP-2, described it “unusually glowing terms,” the Journal Sentinel said. In their article, Zdeblick and his co-authors declared the product to be “the new gold standard” in spine surgery, and stated it was being used “exclusively” at their institutions. A spokesperson for Zdeblick’s facility, UW Hospital, maintained the statements in the article were not an endorsement of the LT-Cage, and noted that when the product came on the market, it was the only one of its type that was available. UW now uses a variety of products, the spokesperson said.
In response to an inquiry by the U.S. Senate Finance Committee, which was investigating payments to doctors by medical companies, UW acknowledged in 2009 that Zdeblick had implanted four kinds of Medtronic devices that he invented or had a role in inventing a total of 179 times in the previous three years. The most implanted device (89 times) was the LT-Cage, the Journal Sentinel said. What’s more, UW Hospital spent $27 million for Medtronic spinal products from 2004 to 2010, according to documents obtained through an open records request.
The Journal Sentinel report does point out that none of the Medtronic royalties received by Zdeblick or his co-authors is from rhBMP-2. While he does receive royalties from the LT-Cage, both Medtronic and UW said he does not receive royalties from Medtronic spinal implants used by UW Hospital.
Still, medical and academic experts interviewed by the Journal Sentinel expressed concern that Zdeblick’s financial relationship with Medtronic may have created a conflict of interest.
“Is that the ideal situation?” asked Arthur Caplan, a professor of medical ethics and health policy at the University of Pennsylvania. “I don’t think so. It is just such a huge sum of money. It’s just too big a connection.” Caplan added that, even with safeguards aimed at preventing conflicts-of-interest, he would discourage Zdeblick from serving as a department chair.
“What kind of message goes out when the chairman of the department who is going to be evaluating promotions is so deep into the pocket of Medtronic?” David Rothman, president of Columbia University’s Institute on Medicine as a Profession. “That message, that you can have it all, that you can take millions from Medtronic and still be chairman of the orthopedics department, that’s a message that should make people uncomfortable.”
In an email to the Journal Sentinel, Robert Golden, dean of the UW School of Medicine and Public Health, defended Zdeblick and pointed to several “safeguards” the school maintains to prevent conflicts-of-interest.
“To my knowledge, Dr. Zdeblick has effectively carried out his responsibilities as department chair to review activities of faculty,” Golden wrote.
For his part, Zdeblick did not provide a comment for the Journal Sentinel article.