Wednesday, December 27, 2006

Medical Meeting Spikes Session on Conflicts of Interest

There seems to be a run of stories about academic fora rejecting discussions of conflict of interest (see most recent post here about how the New England Journal of Medicine seemingly rejected a commentary on conflicts of interest by one of its own "national correspondents.") Now the Boston Globe has published an article by Christopher Rowland about the cancellation of a session on conflicts of interest at the American Society of Hypertension (ASH) 2007 meeting. We previously discussed a controversy at the Society over industry involvement in guidelines it sponsored that featured a broadened definition of "pre-hypertension," one that seemingly would include many more patients as candidates for drug treatment. According to the Globe,
The title of the proposed panel discussion cut straight to the point: "Conflicts of Interest." But attendees at the American Society of Hypertension's spring meeting in Chicago won't get to hear what panelists have to say about financial ties between the drug industry and medical societies and physicians. The society has rejected the session, saying it was 'one-sided' and did not meet 'standards for fair balance and scientific rigor.'

Now, the cancellation itself is causing a conflict, prompting three prominent drug industry critics from Boston who had been invited to participate to accuse the society of stifling debate.

'The society is hiding under a rock,' said Dr. Jerome Kassirer, a former editor of the New England Journal of Medicine, who would have been a panelist.

The panel about conflicts of interest [would have been lead] by Jean E. Sealey, a researcher and former president-elect of the American Society of Hypertension. Sealey has said the drug industry wields too much influence over the society's activities through its financial contributions to the group and by paying for honoraria, speakers fees, grants, and research contracts with individual doctors.

But the society's leadership alleged that Sealey had her own conflicts of interest: While she served on the society's board, her husband, Dr. John Laragh , edited one of the society's academic journals.

Sealey agreed to give up her chance to be president, but was allowed to organize a half-day session for next May's annual meeting.

The group said in a statement that it sent Sealey's panel proposal to its continuing medical education review committee, which determined Sealey's plan to limit the panel to three prominent drug industry critics lacked balance. It suggested adding a Food and Drug Administration official to the roster, but Sealey refused.

In response to questions from the Globe, the society initially said in an e-mail that fair balance is required under national standards for continuing medical education programs, and that its internal continuing medical education committee was compelled to reject the panel on those grounds. In a subsequent e-mail, after Kassirer said there is no such requirement in the national rules, the society said the expectation of fair balance is 'inherent.'
Sealey said the purpose of her proposed panel was to provide a counterpoint to the many industry sponsorships and payments to physicians who are scheduled to present medical information at the meeting. At last year's meeting, she said, 100 of the 165 presenters disclosed financial ties to pharmaceutical companies.

Obviously, the American Society of Hypertension has the legal right to determine what presentations will occur at its national meeting. However, in my humble opinion, the Society's stated reason for rejecting this single panel presentation on conflict of interest was bizarre. As noted above, there is no known requirement that each individual presentation at a medical meeting must in some way be "balanced."

Furthermore, the ASH meeting seems to be one of the many medical meetings in which there is a large amount of industry participation. ASH itself has 12 corporate members, all pharmaceutical companies. At the annual meeting, high-powered pharmaceutical advertising is quite evident, and the meeting web-site includes a pamphlet to promote even more. It suggests that over 70 commercial exhibitors will participate, indicates a vast variety of advertising and promotional opportunities, and claims, "the enthusiastic response to our exhibit area from both participants and visitors affirms our belief that this is one of the most productive exhibit showcases available."

So it seems that one panel on conflicts of interest featuring critics of the pharmaceutical industry would likely be completely over-balanced by the tremendous amount of industry participation elswhere at the meeting.

This case seems to be yet another in our catalog of examples of the anechoic effect. Criticisms of the role of commercial vested interests in medical science are considered impolite in certain venues, particularly venues that unquestioningly feature a large amount of industry support. Such impoliteness is unwelcome, as it might trouble those who are otherwise happy to let the good times roll.

Medical societies, however, ought to think of what they may have sold to finance their continued rolling.


Anonymous said...

The Emperor Has No Clothes.

Steve Lucas

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