Corporate Support and Scientific Integrity
To the Editor:
The medical industrial complex’s compromising of academic medicine’s scientific integrity is one of the most serious issues and problems for current day medical care. Any interested observer can pick out numerous clinical protocols whose design and aims were compromised by the need to come up with a result that would help sell a drug or device. To see the effect on societies such as ASH, one could look at the symposium sensationally titled, “Anemia in the Elderly: A Public Health Care Crisis in Hematology.” Could this emphasis on the issue of mild anemia in the elderly have anything to do with the fact that all the speakers were consultants for companies selling erythropoietin?
There needs to be some way to treat the rampant problem of financial conflict of interest in medical research. Self regulation can never compete with self serving. Thus, as bad as it is, outside regulation or changes in the way research is financed or administratively organized (e.g., the industry’s funding of a truly independent foundation to support clinical research vs. direct industry trial support) is necessary to assure that medical care and medical research are not being perverted by the reality of the profit motive coming before medical need and necessity.
Irwin Nash, MD
Department of Pathology
Hospital of St. Raphael
New Haven, CT
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Re: Corporate Support and Scientific Integrity
To the Editor:
The issue raised by Dr. Nash is serious. But in his passion to identify and correct the abuses, which are real, he uses what I’ll call a Rovian approach. That is the use of incomplete material to damn with a broad brush.
I was a speaker at the anemia education session, and I did record a consultation for Amgen on my disclosures. Actually, I did a single consultation for a company called Tularik that was testing an agent (for a non-hematologic condition) which produced an interesting form of anemia in animal models. Amgen bought Tularik, so I listed both. So much for my role as a consultant for erythropoeitic materials and companies.
However, I was ASH president in 2004, and during our regularly scheduled meetings with the NIH we learned from members of the National Institute on Aging (NIA) about the forthcoming NHANES 3 study that showed an unanticipated and severe impact of anemia in the elderly. Struck by the seriousness of the clinical condition and the lack of hard data, we officers worked with ASH members and staff to run an ASH/NIA-sponsored agenda-setting meeting on anemia of the aged. Financial support for this conference from the relevant companies was neither requested nor accepted; furthermore, the companies were explicitly excluded from attending the conference.
That conference was successful in identifying an agenda, based on which the NIA established an RFA. More than 20 proposals were submitted, and several were identified for funding, pending the passing of a Congressional budget. Certainly, we all hope that the outcome will be good basic and clinical research, which in turn will lead to better care for our patients. That is, of course, what ASH is all about. Consistent with that goal, the ASH Committee on Practice sponsored the education session on anemia of the elderly. Carefully collected feedback indicated that ASH members felt that the education session made an impact on their knowledge and practice.
Stanley L. Schrier, MD
2004 ASH President
Stanford University School of Medicine
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Re: Corporate Support and Scientific Integrity
To the Editor:
I read with disappointment the letter to The Hematologist by our colleague Dr. Nash concerning the topic of corporate support and scientific integrity. In it, he appropriately calls attention to the issue of the potential for compromise of clinical research in pursuit of corporate profit. Unfortunately, he chooses to use the 2005 ASH Committee on Practice educational symposium on anemia of the elderly as the poster child for such abuse. Specifically Dr. Nash writes (and I quote exactly): “To see the effect [of corporate influence] on societies such as ASH, one could look at the symposium sensationally entitled ‘Anemia in the Elderly: A Public Health Care Crisis in Hematology.’ Could this emphasis on the issue of mild anemia have anything to do with the fact that all of the speakers were consultants for companies selling erythropoietin?”
As chairman of this session, and on behalf of the speakers and the Committee of Practice, the “facts” surrounding this session are as follows and not as Dr. Nash suggests:
- This topic was chosen in support of a joint ASH / NIA consensus panel on anemia in the elderly that resulted in a joint research agenda /funding plan. Corporate participation was specifically avoided and there was no consultation with private companies concerning choice of topic.
- Once the topic became known, we were offered a) unrestricted educational funds, b) data availability, and c) logistical support from commercial concerns. All were turned down.
- I am not a consultant for a company that sells erythropoietin, nor have I ever been one.
- Although the title was deliberately worded to be provocative, this was done to call attention to a significant, but poorly recognized health care issue that affects millions of Americans, increases mortality, and contributes in a major way to cardiovascular, renal, neuropsychiatric, and orthopedic morbidity. Given the gentrification of American society, anemia in the elderly represents a major health concern.
In short, corporate interests had no role whatsoever in the construct of this symposium. To imply differently does a disservice to the participants, the Committee on Practice, and the ASH membership.
Vincent J. Picozzi, MD, MMM
Chairman, ASH Subcommittee on Quality
Chairman, ASH Anemia in the Elderly Symposium
Virginia Mason Clinic
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Letters to the Editor — Solicitation
The Hematologist welcomes letters of up to 200 words. These letters may be in response to editorials or on any subject of interest to our readers. Please include a postal address, e-mail address, and phone number. Publication will be based on editorial decisions regarding interest to readers and space availability. We may edit letters for reasons of space or clarity. The Hematologist reserves the right to publish your letter, unless it is labeled “not for publication.”
Letters should be sent to:
Karen Learner, Managing Editor
The Hematologist: ASH News and Reports
1900 M Street, NW, Suite 200
Washington, DC 20036
klearner@hematology.org
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