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Device representatives in hospitals: are commercial imperatives driving clinical decision-making?
  1. Quinn Grundy1,2,
  2. Katrina Hutchison3,
  3. Jane Johnson3,
  4. Brette Blakely4,
  5. Robyn Clay-Wlliams4,
  6. Bernadette Richards5,
  7. Wendy A Rogers3,6
  1. 1 School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
  2. 2 Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
  3. 3 Department of Philosophy, Macquarie University, Sydney, NSW, Australia
  4. 4 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
  5. 5 Adelaide Law School, University of Adelaide, Adelaide, SA, Australia
  6. 6 Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
  1. Correspondence to Dr Quinn Grundy, The University of Sydney, School of Pharmacy, Charles Perkins Centre, Sydney, NSW 2006, Australia; quinn.grundy{at}


Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.

  • health care economics
  • informed consent
  • professional - professional relationship
  • surgery
  • technology/risk assessment

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  • Contributors The entire team conceptualised the manuscript. QG drafted the article and KH, JJ, BB, RCW, BR and WR provided critical revision. All authors approved the final version.

  • Funding This study was funded by Canadian Institutes of Health Research (10.13039/501100000024), postdoctoral fellowship.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data.

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