By Paul Levy

First Posted at Not Running a Hospital on 1/22/2014

Paul Levy, Host of (Not) Running a Hospital

Paul Levy, Host of (Not) Running a Hospital

Regular readers know that I tend to operate in a no-blame mode, i.e., be hard on the problem and soft on the people.  But when someone has violated the public trust in an institution to support the commercial goals of a private company, they have shown such poor judgment that consideration must be given to terminating their employment.

Today’s example is the following advertisement, which appeared in the New York Times Magazine this past weekend.

So far so good: A hospital is bragging about a technology it has in place to serve its customers.  This happens all the time.  While we might question the efficacy of an advertisement for the University of Illinois in attracting customers from across the United States, that is less a question of ethics than one of business judgement.

But, now let’s look at the bottom part of the ad:

Perhaps you have trouble seeing the small print, but the tag line is that the copyright on this advertisement is held by Intuitive Surgical, Inc., the manufacturer of the daVinci robot.  Just above that we have a disclosure that “some surgeons who appear in this ad have received compensation from the company for providing educational services to other surgeons and patients.”

Wait a second.  Whose ad is this?  If it is an ad paid for by the University of Illinois, why doesn’t the University hold the copyright?  If the ad is paid for by Intuitive Surgical, Inc., how can the University allow its name to be used for commercial purposes?

According to its website, “The University of Illinois is the state’s best and most comprehensive public university.”  Hmm, a public university, presumably supported by tax revenues.  The University has a Code of Conduct, which provides, in part:

Those acting on behalf of the University have a general duty to conduct themselves in a manner that will maintain and strengthen the public’s trust and confidence in the integrity of the University and take no actions incompatible with their obligations to the University.

With regard to professional conduct, those acting on behalf of the University should practice:

  • Integrity by maintaining an ongoing dedication to honesty and responsibility;
  • Trustworthiness by acting in a reliable and dependable manner;
  • Evenhandedness by treating others with impartiality;
  • Respect by treating others with civility and decency;
  • Stewardship by exercising custodial responsibility for University property and resources;
  • Compliance by following State and Federal laws and regulations and University policies related to their duties and responsibilities.

Let’s consider how this Code has been violated by this advertisement:

1)  The University has allowed its reputation to be used in a nationally distributed advertisement produced and owned by a private party, in benefit to that party’s commercial objectives.  This is not consistent with “exercising custodial responsibility for University property and resources.

2)  The information presented under the University’s imprimatur is not “reliable and dependable” and therefore undermines the trustworthiness of the institution.  I refer especially to the assertion:  “See facts and clinical data at www.davincisurgery.com/facts.”  This website does not contain the results of objective peer-reviewed, case-controlled data comparing robotic surgery to manual laparoscopic surgery–the expected research standard for academic medical centers.  Instead, the site leads to a document that asserts: “Over the past decade, hundreds of studies have been published on the use of the daVinci Surgical system demonstrating improved surgical outcomes when compared to open surgery.”  Imagine the disciplinary action that would follow if a professor in the university had attempted to publish such self-serving information in support of his or her scientific hypotheses and label it as “facts.”

3)  The inclusion of a surgery technician and nurses in the photograph raises concern about the idea of “treating others with civility and decency.”  What was the process by which those people were invited to participate in the ad?  While it might be based on affection and respect for them as part of the surgical team, were they given a choice? Were they inserted in the picture to give an impression of greater gender and ethnic diversity?  If some of the participants in the photograph have received compensation for their commercial activities, were these staff members treated equally?

4)  On the compensation issue, there is no disclosure as to which surgeons have been compensated by Intuitive Surgical, Inc., the nature of the work they did to receive that money, and the amount of money involved.  Again, the issue of trustworthiness arises.

So, who should be fired for these violations?   Simple: I would choose the highest-rank administrator and clinician who gave permission for this advertisement to be published.