Mark Sabbota, a Hollywood, Fla., cardiologist, regularly implants $5,000 pacemakers in patients at Memorial hospitals in South Broward -- generating, last year alone, more than a half-million dollars in sales for a manufacturer called St. Jude Medical.
Sabbota, public records show, also happens to be partners with a St. Jude sales rep in two corporations that run frozen yogurt shops.
What's yogurt got to do with health care?
Perhaps nothing. Perhaps a lot. The question is connected to an on-going lobbying battle in Washington over a pending disclosure policy intended to more clearly reveal financial ties between physicians and the health care industry -- often-murky relationships that have produced a long history of whistle-blower lawsuits, federal investigations and fines.
Sabbota, in a brief interview, adamantly denied any conflict of interest. "There has been no wrongdoing at all," he said.
Memorial spokeswoman Kerting Baldwin also said the hospital saw no problem with the yogurt arrangement. As a "community" doctor, not a staff employee, Baldwin said Sabbota can select from a list of pacemakers approved by the hospital but has no say over what companies made the list.
"As for why he prefers to use St. Jude, I won't speak for him," she said. "You'd have to ask him that."
But several medical ethics experts said such relationships fall in a gray area. They raise what Kenneth Goodman, bioethics director at the University of Miami, called "red flags" about whether the doctor's motivation in choosing a device "is something other than the best interests of the patient."
"Maybe it's just a good business arrangement that has nothing to do with the devices he chooses," said Charles D. Rosen, a California physician who is co-founder of the Association for Medical Ethics.
"But the issue is public disclosure and transparency. You as a patient should have the right to know about a doctor's financial relationships with companies."
Concerns about the relationship between doctors and health care companies have been simmering for years. Americans are so suspicious of doctors' connections that, in a 2008 Pew Charitable Trusts survey, 86 percent of patients said doctors should not be allowed to get free dinners from drugmakers and 70 percent said doctors shouldn't even be allowed to get free notepads and pens.
The 2010 Affordable Care Act includes a provision intended to address some aspects of these often-cozy relationships. Starting Jan. 1, health care companies were supposed to publicly post how much they were paying doctors. But that provision has been held up in the White House by intense lobbying.
"I don't know why the hold-up, except the intense opposition of the industry," Rosen said. His group, including members of the Harvard Medical School and Cleveland Clinic, wrote a letter to the Obama administration last month protesting the delay.
The group complains that the health care industry is trying to soften the rules so that foreign subsidiaries and doctors engaged in clinical trials wouldn't have to reveal payments. But even if the disclosure rules are implemented, a side deal like Sabbota's yogurt company would not have to be revealed under the new law, Rosen said.
The cardiac device field has been dogged by federal investigations and legal actions for years. Major manufacturers, such as Boston Scientific, Johnson & Johnson, Medtronic and St. Jude Medical, have been among those that have paid fines to settle federal charges that they illegally promoted sales. For the past year, a major federal investigation has been going on in Nevada, examining whether Biotronik was improperly paying doctors to use its pacemakers and defibrillators.
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