CardioExchange Archive

Several Cardiology Fellows who are attending ACC.13 in San Francisco this week are blogging for CardioExchange. The Fellows include Tariq Ahmad, Megan Coylewright, Jeremiah Depta, Kumar Dharmarajan,  Payal Kohli, and  Sandeep Mangalmurti. View the previous post here and the next one here.

Despite baggage and flight delays, I was fortunate enough to arrive to ACC in time to see a series of provocative presentations on the topic of conflict of interest in medicine. The symposium entitled “Regulatory Oversight and Protection of Patients’ Interests” discussed the problems of conflict at both the micro (physician) and macro (governmental) level, and raised issues that all cardiologists have to eventually face.

One of the most compelling presentations was by Dr. Steve Nissen of the Cleveland Clinic, who needs no further introduction. His focus was on the potential financial conflicts that arise between individual physicians and industry. While acknowledging and applauding the benefits of a close working relationship between these two groups, he also notes the obvious potential pitfalls. He argues that red flags should go up for physicians when collaboration moves its priorities from promoting the general welfare to promoting industry revenue. Red flags should stay up when money changes hands in these relationships, creating dual loyalties for the provider.

The unfortunate results of these conflicts can be insidious and far reaching. Impartial scholarship is replaced with articles ghost written by industry, with negative results quietly buried. Legitimate CME is replaced with education that is actually just a promotion vehicle. Most corrosive of all, there is an increase in public skepticism of the motives of all physicians, not just those with dual masters.

Of course, the most difficult conflict of interest to recognize is our own. As Upton Sinclair famously stated: “It is difficult to get a man to understand something, when his salary depends upon his not understanding it.” Perhaps the best we can hope for sometimes is transparency. To that end, the Affordable Care Act of 2010 including a provision known as Physician Payments Sunshine Act (PPSA) which mandates that drug and device companies collect and reveal information on the amount they have provided to physicians; this information will then be made public, so that any person (patient, employer, journalist) can see which doctors are receiving what from whom.

There has been significant delay in implementation of PPSA, but the regulations were finalized on Feb 1, 2013. Companies will have to begin capturing this data on August 1, 2013, and submit reports to the federal government by March, 2014. Sunshine Act data is scheduled to be placed on a public website next fall. In the meantime, interested parties can access some of this
information on http://www.propublica.org/series/dollars-for-docs.

For more of our ACC.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our Coverage Headquarters.