President's Message
Nicholas S. Hill, MD
The role industry should play in professional medical organizations (PMOs) has been controversial to say the least. Viewpoints range from advocating for “a virtually complete ban” (as recommended by a New York Times editorial) to figuring out ways to “manage these relationships” (as suggested by the Heart Rhythm Society president, who was quoted in USA Today). The concern, of course, is that industry money will create conflicts of interest for PMOs and their clinician members and bias them to promote products or prescribe in inappropriate ways. This could undermine public confidence in the objectivity of PMOs and their statements and guidelines. These relationships have not only caught the attention of the media, but also of Congress, which has enacted legislation such as the Sunshine Act, which aims to make physician-industry financial relationships more transparent.
Lost, unfortunately, in the cacophony of contrary arguments is the essential importance of collaboration between medicine and industry. I view this interface as a medical estuary, where the exchange of ideas gives rise to therapeutic innovation, and new agents and devices can be tested. Clinicians and scientists need industry to help finance the development of new discoveries and ideas that will help their patients, and industry needs clinicians to help test the safety and efficacy of new drugs and devices before they can be brought to market. Funding of research in academic medical centers from traditional sources such as the National Institutes of Health is approaching a crisis level and is likely to drop even more in these times of deficit reduction. Thus, industry support of academic medical research has assumed even greater importance.
Organizations like the ATS have an important role to play in defining future relationships of PMOs and their members with industry. In the past, many PMOs derived a portion of their revenues from industry support, with minimal accountability. This is changing rapidly, as pharma guidelines restrict contributions to PMOs and PMOs work hard to become more transparent about sources of funding and how such revenue is spent. Moving forward, we can expect, appropriately so, more scrutiny and need to be prepared to justify our receipt of industry funds and to make their disbursement entirely transparent.
The ATS welcomes industry members into its ranks and values the opportunity to communicate and exchange ideas with industry members, who are encouraged to participate in assemblies and can serve on committees, although they cannot assume key leadership positions. The Drug/Device Discovery and Development, or “Quad D” Committee, is charged with suggesting to the executive committee ways to attract more industry members into the society, as well as “ways that interactions between ATS and industry can be enhanced in a mutually beneficial, transparent and ethical manner.” It is also working with the Members In Transition and Training Committee to develop a program to inform ATS members who might be interested in a career as an industry scientist.
There are risks inherent with maintaining a relationship between industry and PMOs. We must be vigilant about avoiding arrangements that could introduce bias and undermine our integrity. We must be aware that proprietary concerns of an industry partner could discourage the free exchange of information or even lead to withholding of information that could be detrimental to a product in development, but could be very valuable to the greater society. We should work closely with our Ethics and Conflict of Interest Committee as we deal with these kinds of risks.
However, my view is that the potential benefit of our communicating openly and working collaboratively with industry to bring new and more effective therapies to out patients far outweighs the potential risk. The ATS of the future should be a leader in defining the best ways to manage relationships with industry. Rather than seek ways of living without industry, I believe we should develop ways to work with industry transparently, ethically and to our mutual benefit so that, ultimately, we better achieve our overlapping missions and improve the lives of our patients.
I welcome your thoughts. Please feel free to send me an e-mail at nhill@thoracic.org.
