Experience with Carotid Angioplasty and Stenting in a Community Hospital Setting

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• The Committee on Development of the
• American College of Surgeons Foundation
• Cordially invites you to attend the annual
• Medical Industry Breakfast
• Tuesday, October 10, 2006
• 700 am to 900 am
• The Role of Industry in Educating Surgeons
• Opportunities for Collaboration with the
• American College of Surgeons

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Guidelines for Industry and Physicians

• AMA 1991
• ACS 2001
• Pharmaceutical Research and Manufacturers of
  America (PhRMA) 2002
• Advanced Medical Technology Association (Adva
  Med) 2004

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Guidelines for Industry and Physicians

• No cash gifts
• Modest meals
• Textbooks, pens/pads
• Grants for CME go to AMC or society not
  individual physician
• Grants for students, residents, fellows and
  faculty go to AMC
• Free drug samples for patients and physicians

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J Vasc Surg 199317245-8
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• I would say then to the industrial sponsors of
  this meeting, we need your research donations,
  not your Dom Perignon, your support for
  education, not your swing bands. If worst comes
  to worst, we can probably even buy our own booze.

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• One of the hallmarks of a physician is that he
  or she has a dedication to the care of his or her
  patients that transcends economic concerns. As
  physicians, as vascular surgeons, we are not for
  sale.

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• with the increasing interest of the press in
  the issue of conflict of interest in medicine, I
  believe we can be confident that journalists will
  be paying more and more attention to such
  matters.

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Orlando Sentinel August 6, 2006
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• Minnesota law requires drug makers to disclose
  payments to doctors.

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JAMA 2006295429-433
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More Stringent Regulation

• Gifting nothing (zero dollar limit)
• Pharmaceutical samples none for physicians,
  vouchers for patients
• No industry representatives at AMC meetings and
  lunches and in corridors
• Speakers Bureaus AMC faculty should not be paid
  speakers for industry
• Ghost writing no
• Research and consulting contracts to physicians
  must be transparent and with no strings
  attached

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If These Proposals are Adopted
Physician decisions might become more
evidence-based Medical societies practice
guidelines might become less subject to
bias Total expenditures on prescription drugs
might decline
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If These Proposals are Adopted

• Increased sensitivity among medical students and
  house staff to the values of medical
  professionalism and scientific integrity
• Medical society meetings would also assume a more
  professional tone and the substance of the
  programs would become more scientific
• The medical profession will be reaffirming very
  publicly its commitment to put the interest of
  patients first

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If These Proposals are Adopted
This policy would likely reduce the
contributions made by drug and device companies
to CME programs. Companies acknowledge that they
carefully evaluate the market impact of
expenditures and support only those demonstrating
an increased use of their products. Other ways of
funding CME programs will have to be identified.
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N Engl J Med 2005 3526534-535
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2006 NIH Budget

• Increased .5
• NIH projects a decline in the number of Research
  Project Grants (RPG) for the second year in a
  row, no inflation adjustment for most new or
  continuing grants, and a decline in the RPG
  success rate for the fifth year in a row, down to
  21 percent.
• NIH website

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APDS Grant Denial
the grant was declined by the independent
education committee because it was deemed not
sufficiently in line with the strategic needs of
the brand.
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Stanley H. Rosenbaum, MDProfessor of
AnesthesiologyMedicine and Surgery at Yale
University School of MedicineNew Haven,
Connecticut

• Most of the potential or actual conflicts of
  interest relevant to the practicing
  anesthesiologist come about because of the
  contact we all have with the pharmaceutical and
  medical equipment industries. The precise
  conflict originates in the direct bond we have
  with the patient, with the implicit agreement
  that what we do is directly and solely for the
  benefit of the patient and not indirectly or
  subtly benefiting ourselves or our friends,
  outside of the explicit fee we charge for our
  services.