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Heart Docs Reject Claims Of Bias From Industry Money

Many physicians attending the Heart Rhythm Society conference see little cause for concern in the heavy financial support drug and medical device industries provide to medical specialist societies, saying the ties are informative and beneficial to patient care.

SAN FRANCISCO—Outside the giant Moscone Center, Dr. Mark Englehardt paused as a gaggle of scooters drove by carting ads for products made by St. Jude Medical.

“This is kind of silly, isn’t it?” the Raleigh, N.C., electrophysiologist said, gesturing at the surrounding scene.

Idling just feet away were several large buses emblazoned with ads for competing medical device makers Medtronic and Boston Scientific, ready to shuttle attendees of the Heart Rhythm Society’s annual conference back to their hotels.

The society, representing 5,100 professionals who treat patients with irregular heartbeats, received nearly half of its revenues last year from drug and medical device companies. That included more than $5 million from its conference alone.

As ProPublica reported last week, researchers who study conflicts of interest in medicine say such a heavy reliance on industry money can be unhealthy if it influences practice guidelines and medical advice that such professional groups give. But while Englehardt said the barrage of promotions seemed “peculiar,” it didn’t bother him. The drug and device industries are essential, he said, to the millions of patients with irregular heartbeats and the thousands of doctors who treat them.

“I’ve always been rather offended that people who aren’t doctors think I’m susceptible to bribes and corruption,” Englehardt said. “A lot of what you learn about products is from people that sell the products. … You have to learn it somewhere.”

Englehardt was typical of conference attendees interviewed about the relationship between the society and industry. On the whole, doctors said they weren’t worried that the money might bias their decisions or the society’s.

The extent of industry funding has grown within the Heart Rhythm Society—from 37.5 percent of revenues in fiscal year 2006 to nearly half last year, according to the group’s financials

In a blog post Friday about ProPublica’s story, one researcher said doctors need to look at their societies more skeptically.

“The take home message here is how these organizations sell their own membership to industry as a way to add to their funding potential,” wrote Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston.

Before attending annual conferences, Brody said, doctors should check their professional society’s web site to see what kind of pitch is made to exhibitors, who pay large sums for booth space and advertising.

“See how you yourself is [sic] being marketed to the drug and device companies as advertising fodder, whose behavior your society more or less promises to deliver over to the industry if only they invest enough funds in supporting the meeting,” Brody wrote.

In the Heart Society’s case, exhibitors were reminded of the enormous financial clout of its members.

“Physicians and allied health professionals who attend scientific sessions write billions of dollars a year in prescriptions; invest hundreds of millions of dollars a year in equipment; spend tens of millions of dollars a year in product and service purchasing and leasing,” says the exhibitor prospectus for last week’s meeting.

One implantable cardioverter defibrillator, a device to shock the heart back into normal rhythm, can cost more than $30,000. A single electrophysiologist may implant dozens a year.

At the Heart Society event, which ended Saturday, defibrillator makers and other firms splashed promos on hotel key cards, newspapers left at each doctor’s door, staircases and cell phone charging stations, in addition to the buses and billboards.

“I’m pretty immune to it,” said Dr. Jeffrey Moak of Washington, D.C.

Said Dr. Khalid Almuti of Cincinnati: “I’m not going to decide what kind of a device I’m going to put in a patient just because I see a bus that says Medtronic.”

Some doctors acknowledged that the corporate barrage must have some effect. “I hope not, but I’m certain that it does,” said Dr. Christopher Conley of Nashville, Tenn. “I’m sure the companies do their own research. They wouldn’t be here, they wouldn’t be putting all this money out if it didn’t influence people.”

Dr. Edward J. Schloss, also of Cincinnati, suggested another reason for the pervasive ads: Companies may be leery of showing weakness.

“I think it would be great if everybody scaled it down,” he said. “But it may be difficult for one company to scale it down unilaterally without looking inferior in the eyes of the doctors.”

Doctors said the heart society meeting was an important opportunity to learn about new research in their field and see new products on the market. Unlike in many other areas of medicine, they said, electrophysiologists work hand-in-hand with device company representatives to program implantable defibrillators and diagnose problems.

Device company employees are in the operating room during procedures and come to the hospital to respond if a patient’s defibrillator delivers a shock.

“The people in the industry are people I work with every day,” said Dr. Richard T. Smith Jr., a pediatric cardiologist in Charlotte, N.C. “I know all these companies. I know all the people that work for them. They’re actually my friends. Many of my friends are actually competitors with one another.”

Besides, several doctors said, much has changed in the past decade as public attention has focused on conflicts of interest in medicine. Pens and notebooks emblazoned with company logos are verboten at conferences. And corporate sponsored bashes with live music acts disappeared years ago.

Doctors said they were unconcerned by ProPublica’s finding that the society, on several occasions, left out or downplayed information about the risks and limitations of cardiac devices and procedures.

“It’s not their job to educate the public,” Conley said of the society. “The person who actually does the procedure, that is his job.”

One society member who was not at the conference praised the Heart Rhythm Society on his blog for posting details of the money it receives from industry on its website so the public and media can examine it. Many professional groups don’t offer such detailed information.

“It will be interesting to see if other medical societies are as forthcoming as the Heart Rhythm Society has been,” wrote Dr. Westby Fisher of Evanston, Ill. “What is clear is that as dollars get tighter and tighter for health care, the scrutiny of these practices and their potential to influence doctors will only continue to intensify.”

At a sparsely attended conference session Thursday, the society’s leaders laid out their philosophy and policy on industry relationships, why they consider them important and what limits the society imposes on them.

Still, incoming society President Bruce Wilkoff wondered whether the focus on the potential conflicts posed by industry support had become too great.

“We have demonized relationships to such an extent that no self-respecting” young physician or scientist would choose to work with industry, he told the audience.

“It’s time to push back,” he said, adding that the society should publicly stand behind collaborations that can result in improved patient care.

At the end of the session, there were no questions or comments from the doctors in the room.

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