Thomas Stossel Addressed American College of Surgeons: Where Has All this Concern Led?
Thomas P. Stossel, MD, professor of medicine at Harvard Medical School, director of translational medicine at Brigham and Women’s Hospital, and co-founder of the Association of Clinical Researchers and Educators (ACRE), recently gave a keynote address at the industry breakfast for this year’s 97th Annual Clinical Congress for the American College of Surgeons.
ACRE is a not-for-profit, professional medical association which advocates the value of physician-industry collaboration.
During his keynote address, Dr. Stossel discussed the current environment in medical-industry relationships and noted how a small minority of voices is impeding medical and scientific progress with their concern about potential “conflicts of interest” by “decrying the beneficial relationships between industry and medicine.” Dr. Stossel asked the audience, “Where has all this concern led?”
“We have gone from bad to worse,” he said. “We have immense regulatory issues and massive confessions where we disclose our relationships to industry, and these are used to initiate a whole variety of inhibitions in freedom of speech, freedom of association and reward for excellence.”
Dr. Stossel described the current environment physicians practice in today, in which, “All corporate payments to physicians now are disclosed. Peer-to-peer speaking has been curtailed, and physician-industry relationships preclude editorials, journal review articles or service on guideline or Food and Drug Administration (FDA) review panels.”
The reasons given for these restrictions are “that those in industry allegedly live in a separate moral universe than medicine,” Dr. Stossel said. “The idea is that those who work for industry are obligated to lie, cheat, and steal for profit and for your investors.” He maintained that the individuals who make such assertions “have launched the conflict of interest (COI) mania.” However, the evidence for these medical and lay media COI messages does not stack up to reality.
For example, Dr. Stossel pointed to research into the area of COI he conducted a few years ago. The study looked at 101 papers in high-profile journals from the Journal of the American Medical Association to the New England Journal of Medical on physician-industry relationships. While Ninety-six percent of the articles emphasized the risks of those relationships, less than half (44 percent) presented evidence to underpin those conclusions about risk, and less than half (43 percent) acknowledged an alternative viewpoint.
Accordingly, Dr. Stossel asserted that, “There is no evidence at all about the effect of physician-industry relations on patient outcomes, yet 76 percent of these papers claim patient harm.” Moreover, only a handful of papers emphasized benefits of medical-industry relationships based on evidence that did not draw inferences about patient care.
Dr. Stossel also dispelled the perception that physicians and the medical industry have a “cozy” relationship by pointing to the fact that “no evidence exists” for commercial bias in continuing medical education, as we have written numerous times. Instead, as Dr. Stossel correctly pointed out, it is the lay and medical media that have helped perpetuate this COI mania, which is unfortunate because “Despite daunting obstacles, industry relationships have delivered huge value,” Dr. Stossel said.
“Evidence that relationships compromise scientific integrity is weak or false, but legal administration and legal strangulation is harming innovation and education and bodes ill for better patient care,” Dr. Stossel emphasized.
Prior to the keynote address, Amilu Stewart, MD, FACS, Chair of the Corporate and Foundation Relations Committee, American College of Surgeons (ACS) Foundation, presented results of the ACS Survey of Fellows Regarding Industry Relations. Invitations were sent to 27,021 individuals, resulting in a 9.6 percent (2,582) participation rate in responses to three survey questions.
From the survey, 13.3 percent (341) of respondents said they had developed a product in collaboration with medical industry that had benefitted patients. Additionally, 9.7 percent (247) of respondents said that they had developed a surgical procedure in collaboration with medical industry that had benefitted patients. Finally, 45.7 percent (1,172) respondents said that they had participated in a clinical trial in collaboration with medical industry that benefitted patients.
“This was an important survey for us to complete because we had no concept of how involved our Fellows were in collaboration with industry,” Dr. Stewart said.
Thomas R. Russell, MD, FACS, Chair of the ACS Foundation Board of Directors, said the ACS Foundation is pleased to sponsor the Medical Industry Breakfast each year to promote discussions on issues of mutual interest to the medical profession and industry.
David B. Hoyt, MD, FACS, ACS Executive Director and ACS Foundation President, recognized that, ACS “cannot educate or innovate in what we do without our relationship with industry,” and that the medical industry meeting “is an incredibly important relationship, and I want to do everything to foster and continue that.”
Amen. Too many articles are written about the dangers or alleged transgressions that result from physician/industry relationships with little or no evidence supporting the positions. We would never accept assertions of this type if we were talking about clinical trials or even less rigorous medical studies.
It is important to recognize the potential for improper influence and hold ourselves to the highest standards. But it is just as important to defend physicians who can work with industry and still maintain their integrity, by far the majority of physicians. We need more voices representing this point of view.