While industry relationships are vital, transparency must be maintained

Recently many have questioned whether industry relationships between societies and physicians may be detrimental to healthcare due to their potential to cause conflicts of interests (COIs). In July’s issue of HeartRhythm, the Heart Rhythm Society (HRS) deemed industry relationships necessary, but said that it is also imperative that professional societies put forth safeguards to help hinder these types of biases and keep relationships transparent.

“Industry is an important member of this coalition, and HRS’s relationship with industry is critical to the continued growth of the field,” Bruce D. Lindsay, MD, of the Cleveland Clinic and other members of HRS wrote.

“Yet the potential for [COI] in any industry collaboration exists,” HRS members noted.

In March, Michelle Roseman, BA, of McGill University in Montreal, and colleagues found that funding sources or author-industry ties are under-reported in randomized controlled trials. Roseman and colleagues said that COIs may play a role in the framing of research questions, study design and interpretation of study findings; and said that while disclosure may be the first step, it is not sufficient enough to mitigate the effects of these COIs on research. 

Likewise, during a presentation at this year's RSNA, Phillip M. Devlin, MD, of Brigham and Women's Hospital in Boston, said that physicians must be careful when participating in industry relationships and ensure that professional judgements do not harbor COIs. He noted that policies created by professional societies can minimize these types of situations that could put physicians at risk for overstepping professional boundaries.

In 2010, HRS developed the Relationships with Industry Task Force to help consider whether the society should collaborate with industry, why these types of collaborations are important and to help set parameters around these types of industry collaborations. The task force concluded that industry collaboration is vital to achieve HRS’s mission.

However, the task force concluded that due to the potential for COIs, it is “necessary to establish strict ethical standards to protect the credibility of HRS and its members.”

HRS concluded that the benefits of industry collaboration include:

• Problem solving: HRS said that this is fundamental to the development of innovative technology, drug treatments and to research advances and improved clinical care.
• Innovation: This depends on the infrastructure provided by universities and the industry. “The exchange of ideas and scientific presentation at annual scientific sessions often spawns the concepts that shape priorities and lead to innovation,” HRS wrote.
• Development of safe and effective technologies and drugs: This is made possible with collaboration between physicians, scientists, allied professionals, engineers and the pharmaceutical and device industries.
• Development of guidelines and consensus documents: These are influenced by randomized trials that rely on the collaboration between industry and clinicians; and
• The development of standards for transparency in industry: These standards bear directly on the use of industry’s products and the care physicians and allied professionals provide.

Because HRS receives educational, promotional and commercial funding from industry, it would be detrimental to the society's future if these funds were eliminated. Additionally, if these types of funding ceased, the society would be forced to raise membership dues and registration fees.

To help ensure that industry bias does not take place, HRS has come up with four safeguards:

• HRS does not allow companies to place restrictions or provide guidance on CME expenditures;
• All disclosure forms, including those of committee members, presenters and members of the board of trustees are publicly available on HRS’s website;
• HRS maintains control over CME educational programs at regional and national meetings; and
• HRS maintains control of its scientific and health policy objectives.

HRS also offered that it believes industry relationships should be disclosed and said the society has developed an oversight committee that is responsible for auditing disclosures and providing a process to report potential violations.

“The task force concluded collaboration in certain areas among scientists, healthcare providers and industry is critical to achieve this goal,” HRS said. “This decision rests on the principle that the problems faced by our patients cannot be solved if clinicians, scientists and industry work in isolation.

“The task force concluded that HRS has sufficient measures in place to prevent undue influence from industry or introduction of industry bias into HRS-sponsored educational programs, research, scientific documents and policy initiatives,” the society concluded. The society said that these recommendations have undergone a peer review process by HRS’s scientific and clinical documents committee and board of trustees.