Hundreds of Australian women complained of serious and debilitating side effects from the implants. (ABC News: Jerry Rickard)
It should have been a landmark day for women suffering from chronic pain from the use of pelvic mesh for prolapse and incontinence.
Instead, it triggered more concerns.
A Senate report has been handed down and put on the national record a validation of everything so many injured patients have been saying for years.
But as inquiry spearhead Senator Derryn Hinch noted, “there are still a lot of questions to be answered”.
Buried in the report is a recommendation that the Federal Government works with the medical profession to ensure there are systems in place to prevent the “payment of inducements to medical professionals and teaching hospitals”.
Lamborghinis ‘used to market mesh implant’
It raises the question: what inducements?
The Medical Board of Australia’s Code of Conduct specifically asks doctors to “inform patients when you have an interest that could affect, or could be perceived to affect, patient care”.
It led these writers to ask, has anyone ever been to a doctor who has declared to them they receive payments from a company whose products they are about to recommend?
Disclosures made by medical professionals are listed through the Medicines Australia website, but that only covers payments for speaking and educational events for pharmaceutical products.
The Medical Technology Association of Australia has a code of conduct that stipulates issues such as not using “any inappropriate inducement … in order to promote or encourage the use of its products”.
But this code is only binding for those device companies that are association members, from Abbott Australasia to Zimmer Biomet.
As the ABC reported earlier this year the marketing for mesh products was intense with images of Lamborghinis and ski trips to the Swiss Alps used to oversell surgeons on the benefits of using pelvic mesh.
There’s been no evidence, in court or in the Senate committee, of direct kickbacks, incentives or commissions being paid to any medical professional. However the issue of inducements does appear to have come up more than once during the parliamentary inquiry.
Many women said they felt pressured to have a device, with one woman telling the committee that she experienced a peculiar reaction from her doctor during a routine pap smear when she mentioned having mild incontinence.
“Straightaway, like a Jack in the Box, he popped his head up from between my legs, ‘I can fix your urinary stress incontinence’, and subsequently did his utmost to convince me that I needed what he described as, ‘a safe and simple straight forward, minimally invasive, uncomplicated and effective surgery’,” she told the inquiry.
She went on:
“I made it clear that should I agree, I wanted the surgery done privately, but he discovered I had no private health cover and said, ‘I do the very same surgery in the XXX [sic] so I’ll do it there.'”
‘Unusual eagerness’ for vaginal mesh surgery
Another woman told senators that her doctor had shown “an unusual eagerness” to perform mesh surgery even though she was “not aware that she had any symptoms”.
“There was pressure on me to agree on that same day to the transvaginal mesh surgery,” she told the inquiry.
“It was explained to me that if I declined and that surgery was still needed, it would be a lengthy delay before I could reapply to have it done.”
Uro-gynaecologist associate professor Christopher Maher told the committee it was important to look at the role that makers had in getting doctors to start using new devices.
He said those who were “early adopters” of mesh did so with the best of intentions, but that it may have contributed to overuse.
He described a situation where makers would actively promote those specialists who used their products to GPs.
“Sponsoring companies are also actively involved in the education and provision of training to medical specialists,” he said.
The Royal Australian New Zealand College of Gynaecologists says the vast majority of surgeons didn’t have any financial incentive to use particular transvaginal mesh products.
The anecdotes above certainly cast some serious doubts on that.
While there is no evidence of kickbacks, incentives or commissions being paid, it is certainly understandable why some people might believe there is much more to this scandal than just overzealous marketing.
Do you know more? Email email@example.com