Flipping through The New York Times magazine a few Sundays ago, former hospital executive Paul Levy was taken aback by a full-page ad for the da Vinci surgical robot.
It wasn't that Levy hadn't seen advertising before for the robot, which is used for minimally invasive surgeries. It was that the ad prominently featured a dozen members of the surgery team at the University of Illinois Hospital and Health Sciences System. "We believe in da Vinci surgery because our patients benefit," read the ad's headline.
"While I have become accustomed to the many da Vinci ads, I was struck by the idea that a major university health system had apparently made a business judgment that it was worthwhile to advertise outside of its territory, in a national ad in The New York Times," Levy, former chief executive of Beth Israel Deaconess Medical Center in Boston, told me by email.
As Levy scanned the ad further, he noticed that at the bottom the ad bore a copyright for Intuitive Surgical Inc., the maker of the da Vinci system. It included this line: "Some surgeons who appear in this ad have received compensation from the company for providing educational services to other surgeons and patients."
Ads for prescription drugs and medical devices are common, and some feature physician testimonials about why they believe the product works. Physicians also deliver promotional talks for drug and device makers, something we've covered extensively in our Dollars for Docs series.
But a whole hospital department? Levy wondered: Was this kosher?
"I was stunned that a public university would allow its name and reputation to be used in that way," he wrote. "The next day, I did a little research on the university's own website and confirmed that my initial reaction was correct: The ad violated the University's code of conduct and administrative procedures, and likely state law."
Da Vinci robotic systems aren't cheap. The Wall Street Journal reported last year that they can cost up to $2.2 million each, and questions have been raised about their value. The American Congress of Obstetricians and Gynecologists said in a statement last year: "There is no good data proving that robotic hysterectomy is even as good as let alone better than existing, and far less costly, minimally invasive alternatives."
Levy, whose blog is called Not Running a Hospital, began writing a series of posts about the ad. The first, called Time to Fire Somebody, ran on Jan. 22. "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,' " it said.
Levy subsequently wrote a post noting that some of those who appeared in white coats in the ad weren't doctors; one wasn't even a medical professional, administrative director of the University of Illinois at Chicago Robotic Surgery Training Center, according to her LinkedIn profile.
Subsequent posts focused on the hospital's board of trustees, Intuitive's disappointing earnings, and the compensation received by the dean of the University of Illinois College of Medicine at Chicago for serving on the board of directors for drug maker Novartis. Levy forwarded the posts to the president and trustees of the university and suggested that they investigate.
Then, one day this month, Levy received an email from Thomas Hardy, executive director for university relations. It said the ad was paid for by Intuitive, the da Vinci maker, and that neither the university nor those pictured were compensated for appearing in the ad. Nonetheless, Hardy's note continued:
"We asked Intuitive to suspend the ad, and the company agreed, immediately upon learning of concerns expressed about it. Our request was based on a business decision; we were concerned that the ad was not benefiting UI Health."
The president of the University of Illinois system asked his vice president for research to investigate the matter and report back to him by March 15 if policies had been violated.
By writing about the issue, Levy appears to have affected how the university navigates commercial relationships. But the university and Intuitive aren't patting Levy on the back.
In response to questions from me, Hardy reiterated what he had told Levy. He also pointed me to a Boston Globe opinion column that faulted Levy for lapses in judgment in a personal relationship with a female employee while he led Beth Israel Deaconess. Levy said he had admitted his errors publicly and apologized.
Intuitive spokeswoman Angela Wonson said in a statement that she believes the ad was appropriate and that the testimonials from university staff were unpaid. "Intuitive's advertising campaign is intended to educate both the medical and patient communities by using factual information from independent, peer-reviewed studies that prove the safety of our system," she wrote.