At least 11 doctors with the University of Wisconsin School of Medicine and Public Health received more than $50,000 from drug or medical device companies last year, including seven who pulled in six-figure amounts, according to records obtained by the Journal Sentinel.

As part of an effort to enforce more stringent conflict-of-interest rules, UW doctors for the first time have had to specify how much outside income they receive.

The disclosure forms show that orthopedic surgeons, who command some of the highest salaries among university and state employees, also got some of the biggest outside income checks, mostly from companies that make medical devices.

With the outside payments, several of them had total annual income of near or more than $1 million.

Some of the orthopedic surgeons also were among the most vocal opponents to the university's new disclosure requirements, referring to the more stringent disclosure requirements as voyeuristic.

In the past, they and other doctors who earned large sums working as consultants, speakers or from royalties could merely state that they received more than $20,000 without having to tell their patients or the university the actual amount.

The issue of doctors, especially those with university positions, working for drug and device companies has come under scrutiny in recent years, including in congressional investigations, medical journal articles and the media. The Journal Sentinel has published an ongoing series of stories on connections between UW doctors and medical firms.

Topping the list of those receiving large sums from medical companies was a group of UW orthopedic surgeons. They include:

• Paul Anderson, a professor of orthopedic surgery, who got $150,000 for eight days of work as a consultant from medical device-maker Medtronic. Anderson, who could not be reached for comment, also earned a UW salary of $755,000 in 2007.

• Ben Graf, an associate professor of orthopedic surgery, who got $770,000 in royalties from device company Smith & Nephew. Graf, who could not be reached for comment, also earned a UW salary of $591,000 in 2007.

• Clifford Tribus, an associate professor orthopedic surgery, who got $310,000 for 15 days of work as a speaker and consultant and from royalties from device company Stryker Spine. Tribus also earned a UW salary of $618,000 in 2007.

In an e-mail, Tribus said about $250,000 of the $310,000 he got from Stryker was from royalties on an implant invention. The rest was from consulting work.

He said he does not receive royalties from devices he implants in his patients and the patients are informed of his financial relationship.

He said his consulting work involves giving talks about the devices to other doctors, for which he is paid $450 an hour. He said that was a lot different than a doctor being paid to give a talk about a drug.

"These are technology- and technique-driven ideas," he said. "It's not taking a pill with some milk or water."

• The largest sum - $2 million - paid in 2008, went to orthopedic surgeon Thomas Zdeblick from Medtronic.

The money came from royalties on inventions and from working eight days as a consultant.

In an e-mail response last week, Zdeblick said his 2008 income from Medtronic also came from royalties on his patented inventions.

"I do not receive any royalties for cases performed at UW," he added. "Patients are informed that I work on product development with industry."

Zdeblick also received $890,000 in compensation from UW in 2007. He is a professor and chairman of the department of orthopedics and rehabilitation.

In January, the Journal Sentinel reported that Zdeblick received more than $19 million in payments from Medtronic from 2003 through 2007.

The payments, mostly from royalties, were revealed in a letter from U.S. Sen. Charles Grassley (R-Iowa) as part of an investigation of payments to doctors from medical companies that Grassley is conducting.

Doctor heads company

Diane Heatley, an associate professor in the division of otolaryngology-head and neck surgery, received the second highest payment from a medical firm.

Heatley, president and founder of Med-Systems Inc., a Madison-based company that manufactures and markets the SinuCleanse over-the-counter saline nasal wash system, reported receiving $1.3 million from the company and working 40 days.

The company, in which she holds a 37.5% interest, has sold millions of the devices over the years, she said.

Heatley, who works with pediatric patients, said that when nasal washing is deemed appropriate, the family is shown several different washing devices, including SinuCleanse, which is available through UW Hospital.

She said some patients already are using nasal washing when they see her.

"Those who use other manufacturers' systems are never encouraged to switch systems," she said in an e-mail.

When asked about whether she tells families about her financial interest in the device, she said, "Yes. My name and picture are on the box as developer of SinuCleanse products."

Jeffrey Grossman, head of the UW Medical Foundation, said all of the financial relationships will be formally reviewed by the university.

"The entire purpose of our exercise is to address the concerns of the public and the profession about the potential influence of drug and device companies on health care practice," he said in an e-mail.

Because of the influence they hold, university physicians often are sought out by drug and device firms. Often patients are unaware of the financial relationships.

Critics of these arrangements say they increase the cost of medicine, potentially compromise patient care and damage the integrity of medical research.

University doctors often are hired by the companies to work as consultants or to give talks.

That could lead to more prescribing of expensive, brand name drugs when cheaper generics might work just as well, or more costly procedures when less invasive therapy might be appropriate.

It also could lead to more off-label use of drugs and devices. Off-label refers to using a drug or device for a condition for which it was not originally approved, which is legal and often advisable, but which also can lead to expensive prescribing that is not based on sound science.

Trend since 1980s

Arnold Relman, a former editor-in-chief of the New England Journal of Medicine and a doctor since the 1950s, said the financial relationships, which took off in the 1980s, have turned the practice of medicine into a huge business. He said it also is destroying the American health care system.

"We can't afford it," he said.

And simply requiring doctors to disclose how much money they are paid doesn't eliminate their conflicts of interest.

"The time has come for medical schools and universities to recognize that disclosure is not enough," Relman said. "It is time to simply make conflicts of interest off limits.

"People have to choose. Do they want to be salaried members of a medical school or freelance entrepreneurs of a medical company?"

Relman said it was outrageous that seven UW doctors received more than $100,000 from medical firms last year. But, he said, just as troubling are the many others who made less than $50,000.

"It's all bad," said Relman, a professor emeritus of medicine and social medicine at Harvard Medical School. "You can't draw a line."

Practice defended

However, Kenneth Noonan, an associate professor of orthopedic surgery at UW, has an entirely different view.

Noonan said interactions between the medical industry and university doctors are important, and physician scientists can help improve patient care.

"In that capacity, the physician becomes a contractor who has a right to compensation generally achieved through contractual relationships," he said in an e-mail. "These contractual relationships must always bow to the primary interest of the physician and the patient - optimal patient care - but they are not inherently inappropriate."

Noonan, who is a member of the committee that has recommended changes to the UW conflict-of-interest policy, received $181,000 from EBI-Biomet, a medical device company, in royalties from a variety of implant products in 2008.

He said he did not get any royalty money from products implanted at any UW facility.