I recently read The first tycoon: The Epic Life Of Cornelius Vanderbilt. In it, T.J. Stiles describes the infancy of the American capitalism. Monopoly was the goal, and subverting competition, bribery, and bullying the means. Read it, a terrific biography.
It’s been heart warming to read that Vanderbilt’s legacy lives today in medicine. In Las Vegas, one heart device company literally owns the market, including the doctors.
Within the last few years, a little known company called Biotronik has cornered the market on pacemakers and defibrillators at the University Medical Center of Southern Nevada, Last year, 250 of the 263 patients, or 95 percent, who had a heart device implanted at the hospital center got one made by Biotronik.
The company’s hold at the hospital center is all the more striking because its implants were not used there before 2008, and its national share of the heart-device market barely exceeds 5 percent, according to industry estimates.
The devices’ sudden popularity was apparently not left to chance. In mid-2008, Biotronik hired several cardiologists who implant heart devices at the Las Vegas hospital as consultants, paying them fees that may have reached as high as $5,000 a month, company documents reviewed by The New York Times indicate. Those doctors then did the rest.
Medicynical Note: Medical conflicts of interest are nothing new. We’ve seen drug companies literally bribe generic companies with hundreds of millions of dollars to keep less expensive competitors off the market; drug prices increased to gouge seriously ill patients; patient care manipulated to maximize reimbursements; overuse of modalities of treatment to maximize reimbursements; exaggeration of benefits (Avastin) of treatment to maximize reimbursement; conflict of interest (joint replacement) that maximize reimbursements.
Our non-system is devoted to maximizing income through manipulation of markets, not quality or efficiency of care. Cost effectiveness is an almost unknown parameter in the U.S. Cornelius Vanderbilt would be very pleased.