Duke Wins ACC Showdown

This week, the ACC, as an arena for impassioned conflict, didn’t stand solely for the Atlantic Coast Conference. A heated confrontation also occurred at the annual meeting of the American College of Cardiology, where Duke physician Robert Harrington debated the Cleveland Clinic’s attention-loving Steve Nissen on the issue of physicians’ relationships with industry.

Both cardiologists acknowledged historical examples of the marketing influence that pharma and the medical-device industry have had on professional education and, potentially, medical practice. But Harrington painted a more complex picture, in which physicians and medical journal publishers have been complicit in allowing this influence to happen. While Harrington advocated that ongoing relationships with commercial entities are “critical,” he urged clear “firewalls” between physicians (particularly academic physicians) and industry and full access to data from industry-funded research. Harrington also correctly stressed that potential conflicts of interest go beyond money; “scientific hubris” is also in the mix.

And speaking of hubris…

Nissen conversely argued that industry funding to sponsors of continuing medical education (CME) and professional medical societies must cease. He cited a Merck-funded CME program at the ACC’s Cardiosource web site, “Optimizing Patient Outcomes in Acute Heart Failure Syndromes: Strategies to Preserve Cardiorenal Function,” which was sponsored by an accredited* medical-education communications company (Med-IQ) and the ACC.** Without citing specific examples of undue industry influence in the program, Nissen argued that Merck’s reason for sponsoring the program was due to the fact that the company had a novel compound, rolofylline, in development that addressed the condition in question. Nissen called the CME program a “market preparation business activity” and an ultimate “misuse of medical information,” primarily because the drug died in phase 3 development. But Nissen failed to acknowledge the obvious follow-up question: How could Merck influence cardiac practice with this particular CME program if rolofylline can never be prescribed?

Using an even more tenuous example, Nissen implied that the American Heart Association had backed away from a study that linked soft-drink consumption with cardiac risk factors and an NEJM-advocated soft-drink tax, on the basis of the AHA’s alleged marketing relationship with Coca-Cola. As evidence, Nissen offered up the red-dress logo for The Heart Truth educational campaign, which has been prominently displayed on cans of Diet Coke. Nissed charged that the logo comes from the AHA.

However, on this very circumstantial point, Nissen appears to be wrong in his facts. According to MedPage Today, the logo belongs to the National Heart, Lung, and Blood Institute. Moreover, both the AHA and the NHLBI deny that any money has been exchanged between Coca-Cola and their organizations to produce the campaign. The Heart Truth program is solely funded by government entities, according to an NHLBI spokesperson.

Those physicians who argue that ties between industry and medical practice should be severed may have some valid points, but Steve Nissen didn’t deliver their perspective in any compelling fashion in this debate. Like in the recent b-ball champ-ship, the hands-down ACC winner here was (the guy from) Duke.

N.B.–Audio portions of the debate are provided by MedPage Today.

* Nissen called the Accreditation Council for CME, the organization that accredits other organizations to sponsor certified CME, “absolutely pathetic” and a “toothless watchdog.”

** Notably the program included faculty from Duke (acknowledged by Nissen) and the Cleveland Clinic (not acknowledged by Nissen).

Image of The Heart Truth campaign logo from the NHLBI web site.

Addendum: The AHA sponsors the trademarked Go Red for Women campaign, which is supported by Macy’s and Merck, according to the campaign web site. The campaign’s logo (left), while incorporating a red dress, is distinct from The Heart Truth’s logo. Both red-dress logos are trademarked by the DHHS.

03/19/10 addendum: Christopher Cannon, Harvard cardiologist and Cardiosource Editor-in-Chief, reviewed the Merck-sponsored CME program that was criticized by Dr. Nissen and provided a lengthy comment at MedPage Today. Among 5 talks, according to Cannon, 4 did not mention Merck’s (now defunct) drug in development, rolofylline. The talks covered the pathophysiology and epidemiology of the condition in question, possible interventions, and clinical development. Last a case was presented “where the drug is not mentioned.” Cannon counted 130 slides in the CME program, 8 (6%) of which concerned the funder’s drug in development. Cannon concluded, “This is I believe a fair balanced program and it does not meet the charaterization [sic] stated by Dr. Nissen.”