Fights Over Drug Firm Influence
The society's cofounder and longtime editor of the prestigious American Journal of Hypertension, Dr. John H. Laragh, has accused "academic physician/businessmen" who accept industry speaking and consulting fees of improperly coloring the group's activities.
"The lines separating marketing from education have been fractured," Laragh wrote in an e-mail message to physicians in the 3,000-member society.
The episode is a stark example of a broader debate taking place within the nation's medical societies, which represent physicians in virtually every medical specialty. Recently, many of the groups have become more sensitive to the potential for conflicts of interest relating to pharmaceutical industry grants.
Disagreements have flared over industry money used to support the hypertension society's educational programs, as well as the propriety of direct industry payments to physicians who serve as lecturers and consultants. The hypertension organization requires doctors participating in speaking programs to reveal the payments, but does not require them to disclose amounts.
Critics say the payments help companies put a patina of scientific and medical legitimacy on what is otherwise an attempt to increase market share.
"The society is seen as sort of a marketing tool by industry. There is a lot of money to go around," said Dr. Curt D. Furberg, a former member of its executive council and a professor of public health sciences at Wake Forest University in North Carolina.
The stakes for the drug companies are especially high in disease areas like hypertension, where the potential markets are huge (about 60 million Americans have high blood pressure) and where doctors can prescribe among a variety of competing brand-name drugs with similar characteristics.
"Every society that I know of is doing a lot of soul-searching in the area of conflict of interest and ethical responsibilities," said Paul Pomerantz, president of the American Association of Medical Society Executives.
Laragh leveled his charges a week before the society's annual gathering May 14-18 in San Francisco. The move by Laragh, a respected pioneer in hypertension research and a professor at Cornell University's Weill Medical College in New York, highlighted a split in the organization between a group of physicians that expresses wariness about industry participation and a newer faction that embraces it.
The dispute has now spread from the American Society of Hypertension to its official journal, the American Journal of Hypertension, which Laragh controls. He has closed the journal's office, which was located in the same Manhattan office suite as the society, and moved it to a sympathetic colleague's office at the Albert Einstein College of Medicine of Yeshiva University in the Bronx.
The society's president, Dr. Thomas Giles, a professor of medicine at Louisiana State University, said he hopes to repair the rift between the journal and the society. He denied Laragh's charge that drug companies have improperly influenced the society's activities under his watch.
Industry sponsorships of meetings and their payments to doctors, Giles said, are part of a "partnership" between physicians, corporations, and government and can be managed with appropriate disclosure rules. The society estimates that about $1.5 million of its $4.4 million annual budget is met by "unrestricted educational grants" by drug companies. Among the large sponsors of this year's annual meeting in San Francisco were Novartis AG, AstraZeneca Pharmaceuticals LP, and Pfizer Inc.
"We will not put ourselves in the position where were are going to function as the marketing arm for anybody," Giles said. "All academicians who are prominent are asked to give talks. To characterize their efforts as marketing is clearly not correct."
The drug companies
say they spend money on grants to medical societies because it helps get
news out to doctors about medical advances.
"We think it is important for scientific organizations to continue to provide forums in which important information and research is shared," said Carla Burigatto, a spokeswoman at AstraZeneca.
The disagreement has taken on the characteristics of a political mud fight. Laragh's enemies have questioned the size of his American Journal of Hypertension salary $229,000 in 2003 and whether he engineered the selection of his wife, Jean E. Sealey, as the society's president-elect. Sealey is a leading hypertension researcher, but she is not a medical doctor. Giles formed a committee last year that investigated the salary level and found that it "substantially exceeded" the salaries paid by other medical journals, but he declined to discuss the issue in an interview.
Laragh, responding for himself and his wife, dismissed those issues as "low blows." He said this week that the real issue was the drug companies' presence and participation at the society's meeting in San Francisco, which he said reached levels never seen in the history of the 19-year-old society. Previously, industry-sponsored education sessions were confined to "satellite" sessions before and after the society's events. This year, Laragh said, the sessions were intertwined with the rest of the program. The main speaking sessions each day, he said, were sponsored by different drug companies, also for the first time.
Among the doctors he singled out for criticism in his e-mail, alleging that personal business interests were intermingled with society proceedings, was Dr. Michael A. Weber, a leading figure and past president of the society. Weber once conducted research with Laragh and is a professor at the Downstate College of Medicine at the State University of New York.
Weber also is a founding partner of a company in New York, Integrium LLC, which administers clinical trials under contract with pharmaceutical companies. Individual researchers were once limited to one speaking opportunity at the annual meeting, Laragh said, but this year Weber and physicians affiliated with Integrium were given seven chances to speak. At one session, an Integrium physician chaired a meeting to discuss results of a clinical trial of Avapro that Integrium administered. Avapro is a hypertension drug marketed jointly by Bristol-Myers Squibb Co. and Sanofi-Aventis SA.
Weber defended the role that Integrium, Bristol-Myers Squibb, and Sanofi-Aventis played. He said the physicians associated with Integrium did not interpret or disseminate results of the trial.
All medical societies
rely heavily on industry sponsorship, Weber said. "Otherwise we wouldn't
exist," he said.