Cardiac Societies Scrutinized for Industry Conflicts: Fair?

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Thomas M. Tu, MD
John M. Mandrola, MD

Thomas M. Tu, MD, an interventional cardiologist, and John M. Mandrola, MD, an electrophysiologist with Baptist Medical Associates in Louisville, Ky., discuss the complex relationships that medical societies and physician specialists form with the cardiac device and pharmaceutical manufacturers that provide the products to support their specialties.

Q. A May article in USA Today, written by Charles Ornstein and Tracy Weber of ProPublica, stated that "societies that represent specialists" are "one of the areas of medicine that still welcomes largesse." In evaluating the societies that represent your specialties, do you agree with this assessment?

Tu: The purpose of my professional organization, the Society for Cardiovascular Angiography and Interventions, is to promote excellence in the care of patients undergoing cardiac catheterization procedures. Symbiotic relationships are inherent between those who use cardiovascular devices and those who make the tools. Financial donations support physician education, research, quality initiatives and patient programs. If this funding results in better patient care, it is not inappropriate. Of course, vendors are not completely motivated by altruism. As with all corporations, they are interested in profits as well. The public has a right to know the amount of money contributed and for what it is being used. If the true funding was revealed, the public would likely find it primarily reasonable.

Mandrola: It is not surprising that physician-leaders of medical societies welcome largesse, as it would be against human nature to turn it down. The question is not whether financial relationships between industry and medical societies exist, but whether the largesse adversely affects patient care, which is a very difficult question. However, investigative organizations, like ProPublica, keep the important issue of how bias and influence might affect patient care in the minds of both patients and doctors, which is positive.

Tom is right about the symbiosis between industry and medical societies. Such partnerships have facilitated tremendous advances in heart disease care. When I studied cardiology, all we could offer a patient with heart attack was aspirin, beta-blocker and a diagnostic catheterization. Now, we whoosh them into a cath lab, infuse complex blood-thinners, and prop open their blockage with metal stents. People not only survive heart attacks, but they continue their lives seamlessly. This kind of life-saving care required doctors to partner with industry.

Tu: The ProPublica article and other media stories tend to stir up controversy while failing to acknowledge the positive work that results from these relationships.

Mandrola: The ProPublica investigation downplays the fact that real people enjoy the benefits of technology, which I call the "fury of medicine." The same companies that lavish the largesse also make life-saving medical devices. While most investigative journalists, like Ornstein, are well-intentioned, they cannot accurately report from the perspective of a doctor who knows how a cutting-edge device may help his or her patient. Journalists can read manuals and scrutinize p-values, but until they have felt a proprietary wire traverse an impossible s-shaped vein, and then experience the gratitude of the same patient weeks later, it is very difficult to tell the whole story. These upbeat stories are the norm for physicians, yet they are seldom celebrated in mainstream media.

Q. Do medical societies need better disclosure policies?

Tu: Disclosure is mandatory for all scientific meetings and working group sessions. Speakers list companies that sponsor their research or provide them with consulting income. Yet, the lists become moot as everyone receives some support, and therefore, is not an indication of improper conflict. It is naïve to think the sheer presence of industry involvement is inappropriate. In fact, industry often seeks to partner with highly accomplished physicians with unique experiences or ideas, who should not be penalized for their accomplishments. For example, FDA policy prevents its physicians from having any interaction with device companies related to their regulatory duties. The unintended side effect is that the agency has difficulty finding experienced individuals to perform essential clinical studies because those doctors are disqualified.

Mandrola: Tom correctly points out that