Medical group puts stop to talks on drug-firm ties

Three Boston critics contend conflicts of interest need airing

By Christopher Rowland, Globe Staff | December 27, 2006

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 other two -- former New England Journal of Medicine editor Dr. Marcia Angell and Dr. Jerry Avorn, a Brigham and Women's Hospital physician and Harvard Medical School professor -- said they would have been unable to attend the conference. Angell said she had another commitment, and Avorn said he is trying to cut down on speaking engagements. But both joined Kassirer in questioning the society's decision to veto the session on conflicts of interest, which is a hot topic in the medical community.
"It's surprising that they would have taken such a drastic step as shutting down a conversation about this," Avorn said. "In principle, we should be partaking in these discussions. We need more, not less of them."
The episode is part of a continuing struggle within the American Society of Hypertension over how industry money influences medical decisions, how much financial disclosure should be required of prominent physicians, and whether those disclosures should be broadly disseminated or kept private.
Other medical societies also are wrestling with such questions as they increasingly rely on industry money to survive. Critics inside and outside the organizations worry about commercial pressures and the loss of medical independence.
The American Society of Hypertension represents about 2,400 cardiologists and other physicians who research and provide care related to high blood pressure. It sponsors medical meetings, distributes news about research developments, and publishes two academic journals.
Angell, Avorn, and Kassirer were invited to take part in the panel about conflicts of interest 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.
Medical society meetings are typically forums for dozens of medical and scientific panel discussions, presentations of trial results for new drugs, and academic lectures. Many of the events are sponsored directly or indirectly by drug companies. In a few cases, sessions on ethical issues are included, but are largely eclipsed by medical and scientific topics.
The society's president, Dr. Suzanne Oparil , was unavailable for comment, the society said through a public relations firm. 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.
The society said it is trying to be more open about potential conflicts. Its website lists 12 "corporate members" who provide financial sponsorship for its programs, though the amount they donate is not disclosed. The society also said it requires officers, board members, and lecturers to disclose financial interests, including dollar ranges of compensation or grants. But not all of the information is made public. Dollar amounts are available only to society members, who must sign a promise that they will keep the information confidential.
Christopher Rowland can be reached at crowland@globe.com.