Showing posts with label American Society of Hypertension. Show all posts
Showing posts with label American Society of Hypertension. Show all posts
Saturday, July 25, 2009
BLOGSCAN - Reports from the ACRE Meeting
The proceedings at the first meeting of the benignly titled Association of Clinical Researchers and Educators (ACRE) was chronicled on the Carlat Psychiatry Blog here, and on Postscript, the Prescription Project blog here. ACRE, founded by Dr Thomas Stossel (see relevant post here on the sorts of arguments Dr Stossel has made), was founded to defend academics who are paid on the side by drug, biotechnology, and device companies from the complaints of the "pharmascolds." What I found most troubling was that the conference was officially opened by Dr Jeffrey Flier, the Dean of the Harvard medical school, implying a medical school endorsement of this group, and featured presentations by the presidents of the American Association of Clinical Endocrinologists, and the American Society of Hypertension, implying endorsement by these medical societies. But also see the comments by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog that there may be a silver lining to this cloud.
Friday, January 05, 2007
Two Cases Demonstrating the Reluctance of Medical Journals and Scientific Meetings to Air Criticisms of Vested Interests
Two follow-ups on stories recently discussed on Health Care Renewal demonstrate how hard it is to openly criticize the powers that be in health care in the venues on which most physicians depend for clinical and scientific information.
The American Society of Hypertension Panel on Conflicts of Interest
Last week we had posted about how the American Society of Hypertension had cancelled a scheduled panel discussion at its annual meeting about conflicts of interest and industry influence, after Society leadership decided the panel was too unbalanced. However, although the panel was likely to be critical of industry influence, it would have occurred at a meeting with considerable industry participation.
Now Christopher Rowland reports in the Boston Globe:
As we noted earlier, there is likely to be considerable commercial presence at the ASH meeting. At least 70 commercial exhibitors are expected in the exhibit hall. The Society is offering a variety of opportunities for corporate sponsorship of various meeting activities. Doubtless, many of the research projects to be presented were funded by industry, and many of the presenters are employed part-time by industry as consultants and on speakers' bureaus. Yet the Society seemed worried that a single panel presentation might exclusively present critics of industry, so it had to add an industry representative and an academic who has been an uncritical defender of industry to it. There may be some criticism of some practices by the pharmaceutical, biotechnology, and device industries in the media, but this case demonstrates how hard it is to criticize industry in more professional health care circles.
The "Defanged" New England Journal of Medicine Article on Epoetin
Last week, we posted about how the New England Journal of Medicine spiked a commentary by Dr Robert Steinbrook, one of its "national correspondents," that included discussion of commercial involvement in the National Kidney Foundation guidelines that promoted aggressive use of epoetin in anemic patients with renal failure. Instead, the Journal published a commentary by an author who has ties to the National Kidney Foundation, and which did not discuss or criticize the Foundation's commercial support. Steinbrook's commentary was eventually published in Lancet. [Steinbrook R. Haemoglobin concentrations in chronic kidney disease. Lancet 2006; 368: 2191-2193.]
This week the New England Journal of Medicine published another commentary by Dr Steinbrook entitled "Medicare and Erythropoietin." [Steinbrook R. Medicare and erythropoietin. N Engl J Med 2007; 356: 4-5. ] This version omitted any discussion, much less criticism, of industry involvement in these guidelines. Conspicuously absent was this passage found in Steinbrook's Lancet commentary:
Steinbrook recommended,
Such a recommendation also did not appear in the New England Journal of Medicine article.
So it also seems that the New England Journal of Medicine could not bear to publish any discussion or criticism of commercial involvement in this particular instance of guideline development.
[Hat tip: GoozNews. As Merrill Goozner said, the Steinbrook article may have been "unspiked," but it surely was "defanged" in the process.]
Summary
Many physicians learn about clinical medicine, clinical science, and health policy from prominent journals and by attending prestigious scientific meetings. Yet these journals and meeting often are supported by commercial firms and other organizations with vested interests. These well-reputed fora, often regarded as objective, seem singularly reluctant to allow discussion of the role of commercial funding and influence in their proceedings. So not only are physicians who depend on these traditional sources of information likely to be exposed to information that is influenced by those with vested interests, they are unlikely to be exposed to any criticism of the biases that may thus arise.
Of course, in this age of the internet, there are other ways they may yet be exposed to such criticism. The longer the traditional journals and meetings try to pretend such criticism does not exist, the less trust they will inspire.
The American Society of Hypertension Panel on Conflicts of Interest
Last week we had posted about how the American Society of Hypertension had cancelled a scheduled panel discussion at its annual meeting about conflicts of interest and industry influence, after Society leadership decided the panel was too unbalanced. However, although the panel was likely to be critical of industry influence, it would have occurred at a meeting with considerable industry participation.
Now Christopher Rowland reports in the Boston Globe:
The American Society of Hypertension , accused by its critics of stifling debate, has reversed course and says it will host a panel discussion this spring on how pharmaceutical companies influence medical journals and societies.
After the cancellation was reported by the Globe last week, the society's associate executive director, Melissa Levine , said in an e-mail that the society had now decided to add the panel discussion to the agenda for the May meeting in Chicago.
The society is 'committed to conducting a session on conflicts of interest,' Levine said. 'Over the next few weeks we will be working to finalize the session and confirm the speakers.'
But the inclusion of drug industry defenders led one of the original invited panelists, Dr. Marcia Angell , former editor of the New England Journal of Medicine, to question the society's motives, even though she is considering taking part in the session.
'It seems to be standing the whole thing on its head,' said Angell.
She said the original intent of the panel had been to provide a counterweight to the drug industry's sponsorship of scientific papers and physicians at the annual meeting.
The industry advocates added to the panel are Dr. Thomas P. Stossel and William F. Keane.
Stossel, a Harvard Medical School professor and codirector of the hematology division at Brigham and Women's Hospital, said he has tentatively accepted an invitation to participate. He said he looks forward to the chance to defend drug industry involvement in medical societies.
Keane is vice president of clinical development at Merck & Co. Inc. Merck confirmed yesterday that Keane has been invited to present a lecture on 'industry/professional society relationships' but did not say whether he will accept the invitation.
Stossel said yesterday he would use the panel discussion to argue in favor of continued drug company participation and direct financial support of medical societies and doctors.
'There has been 20 years of unopposed air time of this anti-industry, anticommercial criticism,' Stossel said.
As we noted earlier, there is likely to be considerable commercial presence at the ASH meeting. At least 70 commercial exhibitors are expected in the exhibit hall. The Society is offering a variety of opportunities for corporate sponsorship of various meeting activities. Doubtless, many of the research projects to be presented were funded by industry, and many of the presenters are employed part-time by industry as consultants and on speakers' bureaus. Yet the Society seemed worried that a single panel presentation might exclusively present critics of industry, so it had to add an industry representative and an academic who has been an uncritical defender of industry to it. There may be some criticism of some practices by the pharmaceutical, biotechnology, and device industries in the media, but this case demonstrates how hard it is to criticize industry in more professional health care circles.
The "Defanged" New England Journal of Medicine Article on Epoetin
Last week, we posted about how the New England Journal of Medicine spiked a commentary by Dr Robert Steinbrook, one of its "national correspondents," that included discussion of commercial involvement in the National Kidney Foundation guidelines that promoted aggressive use of epoetin in anemic patients with renal failure. Instead, the Journal published a commentary by an author who has ties to the National Kidney Foundation, and which did not discuss or criticize the Foundation's commercial support. Steinbrook's commentary was eventually published in Lancet. [Steinbrook R. Haemoglobin concentrations in chronic kidney disease. Lancet 2006; 368: 2191-2193.]
This week the New England Journal of Medicine published another commentary by Dr Steinbrook entitled "Medicare and Erythropoietin." [Steinbrook R. Medicare and erythropoietin. N Engl J Med 2007; 356: 4-5. ] This version omitted any discussion, much less criticism, of industry involvement in these guidelines. Conspicuously absent was this passage found in Steinbrook's Lancet commentary:
Over the past decade, National Kidney Foundation guidelines have improved the clinical care of patients with chronic kidney disease in many areas, including vascular access and the adequacy of dialysis. They have, however, been questioned for their reliance on expert opinion and because of the close relations between the Foundation, the Kidney Disease Outcomes Quality Initiative (KDOQI) that formulates its recommendations, and the drug industry. In fiscal year 2005, according to its annual report, the Foundation received $19·7 million—57% of its total support—from various 'corporate and organizational partners'. In calendar year 2005, it received $4·1 million from Amgen and $3·6 million from Ortho Biotech, a subsidiary of Johnson & Johnson, the current marketers of epoetin products in the USA. Amgen supported the development of the anaemia guidelines and is acknowledged as 'the founding and principal sponsor of KDOQI.' 11 Of the 18 members of the workgroup, two-thirds disclosed financial associations with Amgen or other epoetin manufacturers or marketers. In an October, 2006, fact sheet, the Foundation responded to 'some controversy [that] has arisen due to the fact that KDOQI guidelines have been supported by industry. The NKF continually reviews its policies and procedures to safeguard the work product of KDOQI and to ensure that no sponsorship funds contributed to the NKF ever influence the content of any of the KDOQI guidelines.'
Steinbrook recommended,
Physicians and dialysis facilities need updated guidance about the management of anaemia and what is best for patients. Given the billions of dollars at stake for the drug and dialysis industries, such guidance is likely to receive the broadest acceptance if developed without industry support, and by experts without relevant financial associations. This might be accomplished under the auspices of the National Institutes of Health Consensus Development Program or the Agency for Healthcare Research and Quality.
Such a recommendation also did not appear in the New England Journal of Medicine article.
So it also seems that the New England Journal of Medicine could not bear to publish any discussion or criticism of commercial involvement in this particular instance of guideline development.
[Hat tip: GoozNews. As Merrill Goozner said, the Steinbrook article may have been "unspiked," but it surely was "defanged" in the process.]
Summary
Many physicians learn about clinical medicine, clinical science, and health policy from prominent journals and by attending prestigious scientific meetings. Yet these journals and meeting often are supported by commercial firms and other organizations with vested interests. These well-reputed fora, often regarded as objective, seem singularly reluctant to allow discussion of the role of commercial funding and influence in their proceedings. So not only are physicians who depend on these traditional sources of information likely to be exposed to information that is influenced by those with vested interests, they are unlikely to be exposed to any criticism of the biases that may thus arise.
Of course, in this age of the internet, there are other ways they may yet be exposed to such criticism. The longer the traditional journals and meetings try to pretend such criticism does not exist, the less trust they will inspire.
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,
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.
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.
Monday, May 22, 2006
New Dispute Over Industry Involvement with a New Definition of Hypertension: "Monetarization of Medicine?"
Almost a year ago we discussed a dispute that had broken out within the American Society of Hypertension (ASH) about the role of industry in and conflicts of interesting affecting the society's work.
The New York Times has followed-up with another story, this one highlighting the society's role in a new and more expansive definition of hypertension. This definition included some people with "pre-hypertension," previously defined as a blood pressure between 120/80 and 139/89, within a newly defined "state 1 hypertension" group. This expanded definition appeared in an article whose lead author was the current President of ASH (Giles GD, Berk BC, Black HR, Cohn JN, Kostis JB, Izzo JL Jr, Weber MA. Expanding the definition and classification of hypertension. J Clin Hypertens 2005; 7: 505-512.) The Times noted that "of the seven doctors who wrote the proposed new definition, six have said they served as consultants and speakers for pharmaceutical companies that make blood pressure medications. The seventh is a consultant and stockholder in a company that markets a diagnostic method to measure damage to blood vessels."
The Times also noted "the work of the group that developed it was financed by $75,000 in unrestricted drug industry grants from Merck, Novartis and Sankyo...." Furthermore, a society staffer "confirmed that the dinners [to discuss the new guidelines] were financed by $700,000 in grants, also unrestricted, from the same companies."
Internal critics within the society criticized the process. "This is about the monetarization of medicine," said former society President Dr Michael H Alderman, who had withdrawn from the group which proposed the new hypertension definitions. Furthemore, he noted, "all this has got the ring of seeming to be of great benefit to the pharmaceutical industry without clear evidence that it's going to be the same benefit to the public." Dr Curt D Furberg, from Wake Forest University, also withdrew from the group. He charged that "its work was not evidence-based, ... [and] 'the industry wants to sell drugs and to as many people as possible.'" Jane E Sealey, who had been President-Elect of the society, said, "the truth of the matter is that we have many members who are leaders in our society who are making well into the six figures from their pharmaceutical-company-supported activities." Dr Sealey immediately resigned her presidency at the society's annual meeting, according to theHeart.org.
ASH President Giles countered that "the organization had always maintained a firewall between its activities and industry funding. 'We don't take money that has strings attached to it.'" One of the authors of the new hypertension definition, Dr Joseph L Izzo of the University of Buffalo, said "there are those who accuse us of being nothing more than shills of industry: a lot of us take pretty great offense at that."
This seems to be another example of how disease definitions get expanded, often with some degree of participation by pharmaceutical companies who have interests in increasing the market for their products. Note also that the sorts of possible conflicts of interest described may have largely unconscious effects on those affected, as we have discussed. So the indignation of people who are not conscious "shills of industry" is real, but perhaps misplaced.
Furthermore, this is another case that suggests physicians and patients need to be increasingly skeptical about the apparently authoritative guidelines that now rain down on us.
Finally, the Times also reported that Dr Steven E Nissen, new president of the American College of Cardiology, "suggested that the medical profession had become addicted to industry money just as the nation was addicted to foreign oil." Maybe it's time to kick the habit.
The New York Times has followed-up with another story, this one highlighting the society's role in a new and more expansive definition of hypertension. This definition included some people with "pre-hypertension," previously defined as a blood pressure between 120/80 and 139/89, within a newly defined "state 1 hypertension" group. This expanded definition appeared in an article whose lead author was the current President of ASH (Giles GD, Berk BC, Black HR, Cohn JN, Kostis JB, Izzo JL Jr, Weber MA. Expanding the definition and classification of hypertension. J Clin Hypertens 2005; 7: 505-512.) The Times noted that "of the seven doctors who wrote the proposed new definition, six have said they served as consultants and speakers for pharmaceutical companies that make blood pressure medications. The seventh is a consultant and stockholder in a company that markets a diagnostic method to measure damage to blood vessels."
The Times also noted "the work of the group that developed it was financed by $75,000 in unrestricted drug industry grants from Merck, Novartis and Sankyo...." Furthermore, a society staffer "confirmed that the dinners [to discuss the new guidelines] were financed by $700,000 in grants, also unrestricted, from the same companies."
Internal critics within the society criticized the process. "This is about the monetarization of medicine," said former society President Dr Michael H Alderman, who had withdrawn from the group which proposed the new hypertension definitions. Furthemore, he noted, "all this has got the ring of seeming to be of great benefit to the pharmaceutical industry without clear evidence that it's going to be the same benefit to the public." Dr Curt D Furberg, from Wake Forest University, also withdrew from the group. He charged that "its work was not evidence-based, ... [and] 'the industry wants to sell drugs and to as many people as possible.'" Jane E Sealey, who had been President-Elect of the society, said, "the truth of the matter is that we have many members who are leaders in our society who are making well into the six figures from their pharmaceutical-company-supported activities." Dr Sealey immediately resigned her presidency at the society's annual meeting, according to theHeart.org.
ASH President Giles countered that "the organization had always maintained a firewall between its activities and industry funding. 'We don't take money that has strings attached to it.'" One of the authors of the new hypertension definition, Dr Joseph L Izzo of the University of Buffalo, said "there are those who accuse us of being nothing more than shills of industry: a lot of us take pretty great offense at that."
This seems to be another example of how disease definitions get expanded, often with some degree of participation by pharmaceutical companies who have interests in increasing the market for their products. Note also that the sorts of possible conflicts of interest described may have largely unconscious effects on those affected, as we have discussed. So the indignation of people who are not conscious "shills of industry" is real, but perhaps misplaced.
Furthermore, this is another case that suggests physicians and patients need to be increasingly skeptical about the apparently authoritative guidelines that now rain down on us.
Finally, the Times also reported that Dr Steven E Nissen, new president of the American College of Cardiology, "suggested that the medical profession had become addicted to industry money just as the nation was addicted to foreign oil." Maybe it's time to kick the habit.
Thursday, June 16, 2005
Dispute at the American Society of Hypertension Over Industry Involvement
The Boston Globe reported that a dispute has broken out at the American Society of Hypertension over the influence of pharmaceutical companies and conflicts of interest. Things have gotten pretty messy, so it's not easy for an outsider to tell what are at its roots.
There are two factions, one who "expresses wariness about industry participation and a newer faction that embraces it," according to the Globe.
In the first faction is Dr. John H. Laragh, a society cofounder and editor of the American Journal of Hypertension. In an email to the Society's membership, he charged that "the lines separating marketing from education have been fractured." Prof. Curt Furberg, former member of the Society's executive council, agreed that "the society is seen as a marketing tool by industry. There is a lot of money to go around."
Furthermore, Laragh said that industry involvement has increased at the society's annual meeting. This year, industry-sponsored sessions, instead of being isolated as "satellites," were "intertwined with the rest of the program." He noted that one society member, who also is a founding partner of a company that administers clinical trials under contract with the pharmaceutical industry, chaired a meeting to discuss the results of a trial that his company administered.
In the second faction is the President of the Society, Dr. Thomas Giles. He said that industry involvement is "part of a 'partnership' between physicians, corporations, and government and can be managed with appropriate disclosure rules, " according to the Globe. He noted that unrestricted educational grants from pharmaceutical companies, notably Novartis, AstraZeneca, and Pfizer, financed about $1.5 million of the Society's $4.4 million budget. He said, "we will not put ourselves in the position where were [sic] are going to function as the marketing arm for anyone."
Laragh has also acquired "enemies," who questioned his editorial salary ($229,000 in 2003), and whether he "engineered" his wife's new position as President-Elect of the Society.
Not a pretty picture, but I guess that more open discussion about the role of industry in scientific and clinical societies may do some good.
There are two factions, one who "expresses wariness about industry participation and a newer faction that embraces it," according to the Globe.
In the first faction is Dr. John H. Laragh, a society cofounder and editor of the American Journal of Hypertension. In an email to the Society's membership, he charged that "the lines separating marketing from education have been fractured." Prof. Curt Furberg, former member of the Society's executive council, agreed that "the society is seen as a marketing tool by industry. There is a lot of money to go around."
Furthermore, Laragh said that industry involvement has increased at the society's annual meeting. This year, industry-sponsored sessions, instead of being isolated as "satellites," were "intertwined with the rest of the program." He noted that one society member, who also is a founding partner of a company that administers clinical trials under contract with the pharmaceutical industry, chaired a meeting to discuss the results of a trial that his company administered.
In the second faction is the President of the Society, Dr. Thomas Giles. He said that industry involvement is "part of a 'partnership' between physicians, corporations, and government and can be managed with appropriate disclosure rules, " according to the Globe. He noted that unrestricted educational grants from pharmaceutical companies, notably Novartis, AstraZeneca, and Pfizer, financed about $1.5 million of the Society's $4.4 million budget. He said, "we will not put ourselves in the position where were [sic] are going to function as the marketing arm for anyone."
Laragh has also acquired "enemies," who questioned his editorial salary ($229,000 in 2003), and whether he "engineered" his wife's new position as President-Elect of the Society.
Not a pretty picture, but I guess that more open discussion about the role of industry in scientific and clinical societies may do some good.
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