Innovation in medicine has led to advances directly benefitting patients. Yet recent legislation has created intense scrutiny of the relationship between surgeons and industry. Critics argue that surgeon-held patents and royalties incentivize surgeon loyalty, influencing decision making as to which devices are used intraoperatively. We explored the potential for inventor-related conflicts of interest. We searched patent records from the United States Patent and Trademark Office for every diplomate recognized by the American Board of Neurological Surgeons (4868 neurosurgeons). We also searched physician payment registries of the 5 largest device makers; of these, Medtronic, DePuy, and Zimmer were the only companies with available registries. A total of 147 neurosurgeons (3.0%) hold a total of 582 patents; the number of patents held per neurosurgeon ranges from 1 to 53. The fields in which patents are held include tumor (125), spine (98), vascular (54), trauma (27), stereotaxy/image guidance (88), pain (19), peripheral nerve (2), electrical stimulation (63), and pediatrics (9); surgical instruments (59), drug delivery (17), and other (21) account for the remainder. The total amount of royalties received by neurosurgeons in 2010 is expected to be $13,223,000 (minimum: $7K, maximum: $8.261M). Despite public and legislative perceptions of widespread conflicts of interest, there are relatively few neurosurgeons who hold patents and receive significant royalties.

Device innovation in neurosurgery: controversy, learning, and future directions.

Objective Neurosurgeons have taken on the role of innovators, continuing to move the field forward over the centuries. More recently, innovation has taken the form of new technological devices and therapeutics, which require patenting. The aim of this study is to identify major areas of innovation in the field of neurosurgery by evaluating patent records. Methods This study quantifies the number of patents the American Association of Neurological Surgeons (AANS) neurosurgeons hold across different subspecialties. The United States Patent and Trademark Office (USPTO) patent database was queried using the names of 7,293 AANS members who filed patents between 1976 and 2019. Results A total of 346 (4.7%) AANS neurosurgeons hold a total of 1,025 patents. The number of patents held by each neurosurgeon ranged from one to 109. The areas that patents were filed under include cellular and genetic science (40), drug delivery (45), image guidance (82), neuromodulation (52), pain (7), peripheral nerve stimulation (24), spine (398), surgical devices (148), trauma (16), tumor (78), vascular (67), and other (68). No patents were filed under pediatrics (0). The fields with the greatest number of filed patents are spine, instruments/devices, and image guidance. Conclusion Given the technical nature of the field of neurosurgery, instruments and devices that improve localization, visualization, targeting, and spinal reconstruction are often in demand. Furthermore, since the rates of spinal procedures and implants continue to increase, higher patenting may be motivated by the opportunity to develop new products that can result in royalty payments to neurosurgeons. The advent of new technologies undoubtedly continues to push the field of neurosurgery forward.

Patents and Innovation Among Neurosurgeons from the American Association of Neurological Surgeons

Ethics and Medical Patents

Equilibrium in economics solely concerns efficiency properties defined over the commodity space. But, in different and often conflicting ways, members of society judge market performances also on equity rounds and express preferences not only over bundles of commodities but also over social relations and social orders. Social equilibria are states of the system where institutional arrangements, including market processes and outcomes, that make up for the quality of social life are considered just, i.e. fair and legitimate. “Justice” entails guaranteeing minimum efficiency levels in the allocation of resources, fairness in distributive outcomes and freedom to choose among alternative organisational arrangements. Legitimacy of procedures and outcomes derives from constitutionally grounded democratic decision-making processes. A conceptual framework is elaborated to discuss types of social equilibria and conditions for their emergence and reproduction.

On Social Equilibria

The definition of memory knowledge that p put forward in this paper is nontraditional in that the justification for the belief that p which constitutes that knowledge is not located in any memory-impression or other present state of the subject. Rather it is the subject's actual past justification for p, or a proper part thereof, that justifies this present belief that p. It is argued (1) that the notion under definition is that of knowing straight from memory, (2) that an adequate definition here must take into account a difference, as to conflicting evidence one does not possess, between evidence one has forgotten and evidence one has never had, (3) that compared to Ginet's traditional definition (1975), the definition has several advantages, and (4) that the definition handles at least one type of situation where there can be memory knowledge that p without previous knowledge that p.

Justification in memory knowledge

Markets and Morals*: A Response

In this paper I want to discuss two separate problems about memory, connected in that they both have to do with memory as a source or ground of knowledge.

Don Locke

Papers

Markets and Morals*: A Response

Memory, Memories and Me