The debate whether industry support of academic activity is appropriate and can be managed effectively has increased over the last several years. While most agree that industry support has been vital to the development of new therapies to treat diseases, there also have been reports of egregious conflicts of interest from all sides—industry and academia.
A good example of the debate taking place occurred at ACC10 last March. Robert Harrington, MD, of the Duke Clinical Research Institute, and Steven Nissen, MD, of the Cleveland Clinic, engaged in a spirited debate about how to fix the problem.
Harrington argued, “No engagement with industry is misguided and bad for public health,” urging a “more appropriate relationship with industry versus abandoning that relationship all together.” Nissen countered by saying industry influence must be strictly controlled. “You can’t take industry money and be independent,” he said.
The ACC proposes that properly managed partnerships are absolutely critical to maintaining scientific progress in cardiology and other specialties. The college relies on industry funding to advance cardiovascular research, as well as workforce development, diversity, medical education and lifelong learning. Without this funding, efforts to provide meaningful, unbiased education and improve quality would be crippled.
Rather than restricting or avoiding industry funding for such activities, the college has focused on managing relationships with industry. In addition to maintaining stringent industry relationship principles, the college has signed onto the Code for Interactions with Companies that was recently released by the Council of Medical Specialty Societies. The code, which the college helped create, is meant to increase transparency and set a universal standard for independent program development and independent leadership.
The ACC also has enacted organizational firewalls between the development and fundraising related to commercial support and the college’s programmatic activities and personnel. These firewalls are designed to ensure that the ACC’s relationships with drug and device companies do not influence the scientific or educational content the college produces. In addition, the ACC adheres to internal policies, as well as external ones, that prohibit companies providing support from exercising any influence or control over programmatic content, speaker/faculty selection, program format, planning, partnering arrangements, program evaluation methods and related matters.
To bring a more evidence-based medical perspective to the college’s relationships with industry, the ACC recently created a new “chief medical officer” position, of which I have been hired to fill. This position is designed to establish medical-to-medical relationships with pharmaceutical, device and other industry partners. The ultimate goal is to ensure appropriate and high quality patient care.
Given some of the recent cardiovascular-related drug controversies over the last year, this position has helped to make sure that the college is providing its members with the most accurate information to take back to their patients (for example, with rosiglitazone). In addition, the role of chief medical officer will seek to build relationships with other professional medical societies and organizations to ensure relationships with industry principles are aligned to the extent possible. This is particularly valuable when it comes to developing joint clinical documents and/or joint educational content.
In general, the ACC takes the issue of transparency seriously. If done right, future relationships with industry will focus on areas of commonalities versus conflicts of interest, and patients will continue to benefit from the research and education these relationships provide.
Dr. Solomon is the chief medical officer at the American College of Cardiology.