Thursday, July 31, 2008

Odd note in a story on a national artificial joint registry

The NYT joins a call for a national joint registry to find problems sooner.

Makes sense, if the FDA had not been gutted by Bush it would probably have done this years ago.

The interesting bit, however, is the article unconsciously suggests an alternative approach:
The Evidence Gap - Experts Seek a Data Safety Net for Joint Replacements -

.... The use of joint registries has proven beneficial abroad. In Australia, regulators use such data to force manufacturers to justify why poorly performing hips or knees should remain available, and products have been withdrawn as a result. In Sweden several years ago, surgeons alerted by their national registry stopped using a badly flawed hip long before their American counterparts did. A few medical organizations here, like Kaiser Permanente, operate their own registries to good effect and the Hospital for Special Surgery in New York has recently set up a registry....
If I were the governor of MN, I'd use the Swedish and Kaiser registries. How big a registry do we really need?

The NYT story incidentally illustrates how corrupted we physicians are. The physician profiled received lots of money from the hip replacement vendor. He eventually bit the hand that fed him, but we have lots of experimental data to show that paying "consultants" delays or softens any potential "bites".

In the absence of a national registry, or the use of Swedish and Kaiser data, paying off surgeons is a good investment. Not as great an investment as funding a helpful Senator's reelection, but pretty good.

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