While some argue that physician-industry relationships may be laced with bias and potentially create conflicts of interest, the European Society of Cardiology (ESC) argued that if done correctly, these relationships can help improve clinical practice, according to an executive summary on continuing medical education (CME) published March 1 in the European Heart Journal.

“Medical advances have often come from basic and clinical research carried out by academics, pharmaceutical and medical 'device' companies alike,” the ESC white paper read. However, in some cases these industry-medical education relations could hold bias.

According to the statement, “communication may lack objectivity for commercial reasons, and so when industry supports medical educational activities or scientific meetings, there is a risk of bias.” To avoid these types of bias, many societies have tried to eliminate types of relationships that could have the potential to influence clinical decision making and create a conflict of interest.

“There is disquiet both within the medical profession and in the media about the influence of the healthcare industry on prescribing patterns and on the use of medical devices by healthcare professionals,” according to the statement.

Many in the industry have raised concerns that physician ties to the device or pharmaceutical industry may create ethical conflicts of interest that could affect prescribing patterns.

Weighing the importance of medical education
To provide the best care to patients, physicians must be in tune with the most innovative and credible medical developments. One way to do so is through CME; however, these programs tend to rely on public funding and are usually expensive, and are often mandatory for physicians to practice medicine.

While public funding is not usually an option, the ESC said that if they remain unbiased, industry relations are often necessary and acceptable, as long as they are disclosed. The society offered that these CME courses should be evaluated based on scientific merit and quality, among other factors.

The ESC said its specific goal is to reduce cardiovascular disease across Europe and it attempts to do so by “providing balanced and neutral educational resources and scientific communication.”

The white paper noted that CME organizations received $1.2 billion in 2007 alone, which was likely funneled into activities that are “ineffective in changing clinical behavior and improving patient outcomes.” These are the types of activities that ESC asked to be ceased.

In the article, the ESC mentioned its own approach toward keeping CME unbiased. Each year at the ESC Congress program and sessions are put together by nearly 50 Congress Programme Committee members, none of whom are industry employees.

ESC has outlined a specific code that describes proper CME relationships and how to keep these types of relationships transparent.

Some of the requirements are as follows:

• Members must fill out a declaration of interest form;
• Sessions must be based on scientific merit;
• Speakers must show slides with conflicts of interest;
• Company products cannot be advertised in lecture theaters or meeting rooms; and
• Transparency requirements are the same for distance learning courses and internet-based activities.

The society said that relationships with industry are essential, particularly due to the lack of government funding. However, these relationships must remain transparent.

“Of course, private companies only have a future if they are profitable and in a market economy they have a legitimate right to promote their products and need to do so to remain successful,” ESC added.

In the longer term, ESC said that the education of physicians by industry is most effective when the information is presented as “impartial” and “accurate.” Additionally, the society noted that if proper treatments are delivered to the proper patient at the proper time, it will benefit not only the patient but also the device or pharmaceutical company.

"The implementation of medical advances is only possible if they are communicated effectively, and every cardiologist has a professional and ethical duty to keep up-to-date to offer patients the best possible care based on this progress," ESC President Michel Komajda, MD, said in a statement. "Without the healthcare industry's support for the provision of continuing medical education the onus would inevitably fall on the public sector, which is clearly not viable in light of today's challenging economic conditions across Europe."