You Scratch Our Back, But We Can’t Be Seen To Be Scratching Yours, Says European Society of Cardiology

In short

The European Society of Cardiology (ESC) recently published a White Paper on the relationship between professional medical associations and the healthcare industry, concerning scientific communication and continuing medical education (CME). The White Paper addresses the concern that industry funding of CME is biased or creates potential conflicts of interest. It can be sourced from the ESC website here.

The article is also covered extensively on policymed.com, here.

Background

The gist of the piece is that the ESC acknowledges that continuing medical education is vital in providing patients with the best possible care. Yet it is also “expensive, and relying completely on public funding is not a viable option for Europe at the current time, and nor is it likely to be so in the foreseeable future.”

The ESC therefore proposes that “in the absence of alternative funding, maintaining links with industry is appropriate – and indeed necessary-as long as educational and scientific products remain independent, effective and unbiased, and as long as the relationships between ESC experts and industry are transparent and appropriately disclosed.”

It argues that “If the calls to ban industry support of medical associations were to be heeded before alternatives were in place, then opportunities for CME would be severely compromised.”

Transparency

So the ESC believes it can have it both ways in a sort of “you scratch my back and errr, that’s it” fashion. Indeed it puts in place what it calls a “sample of (these) well established, effective and robust measures” including the following:

  • Every member must fill in a declaration of interest(DOI) form
  • Sessions for any programme must be based solely on scientific merit
  • All chairpersons and speakers must (when delivering a session) show a slide with their disclosure of interests and the audience must have time to read all of its contents
  • Company products must not be advertised in the lecture theatre, meeting room or conference hall
  • The requirements for transparency are the same for distance learning courses and internet-based educational activities

Dealing with a few of these from the perspective of the industry watcher then:

DOI form? Signing a form to say company X has just provided you with a training course does not say “…so I will not be biased towards their products”. Clearly the company expects to curry some sort of favour, even if that favour takes the form of a clinician feeling comfortable with a device or technique and therefore more comfortable using it. Unless a company gains “something” it wouldn’t provide the expensive service. Signing a declaration of interest therefore provides only a thin veneer of transparency.

Sessions based on scientific merit? Who decides? Most papers have “some” scientific merit, even if under the skin they are plugs for certain products.

Showing a slide with disclosure? Fair enough, but what does the audience “see” when they see this slide? Some will instantly switch off, assuming partiality. Some will think the content truly impartial because the speaker is a fellow professional. The slide has actually done nothing to render the speaker truly impartial. In fact, by putting it up, the speaker can actually get away with saying pretty much anything because he’s declared an interest. Where does that get the audience? And what constitutes a declarable “interest”? Going on a course, having a study supported financially?

No advertising in lecture hall? Does this extend to materials such as programmes, “instructional” brochures?

There may be one further problem with the whole concept of companies supporting medical associations. Money. Companies which support associations typically appear as bronze, silver, gold, platinum or whatever other euphemisms for ever increasing amounts of “sponsorship” are used. The underlying problem here is that far from levelling the playing field for the ankle biter companies which are vital in providing tomorrow’s technological solutions and indeed in keeping the big guys honest, this approach favours the companies with the deepest pockets. It really doesn’t matter what declarations of interest get waved around if the big companies have locked out sponsorship with their marketing budgets.

It’s undeniably tricky and we can’t pretend to have the answer. The only way to ensure true impartiality is to ban clinicians from using products from companies providing educational support. If companies are truly to act in the sort of altruistic fashion that is the logical extension of the ECS argument, they should have no problem with that.

Otherwise it’s just the same old story of big companies holding the community to a form of ransom, albeit under a cloak of “good behaviour”, isn’t it? Again, that’s life when clinicians are allowed to and indeed have to make choices about how to spend our money. Unless we’re about to dismantle the capitalist component of medtech society, grinding to a technological stand-still and operating in the medical equivalent of the former Soviet Union, then that’s how it is. But dressing it up as somehow free from any commercial influence because of a few demonstrations of moral rectitude is maybe a bit hypocritical.

Source: European Society of Cardiology, Policymed.com, medlatest staff