Dear Readers,

There has been a great deal of negative attention lately to relationships between physicians and industry. A front-page story in the Chicago Tribune newspaper in October was devoted to a list of all physicians in the Chicago area who received over $100,000 in compensation from the pharmaceutical industry in the past year.¹ It does seem that something is awry when an individual practicing physician earns $250,000 from a drug company, but the reactions by the media, legislators, and some professional medical associations (PMAs) have demonized all relationships between physicians and industry.

Last year, the Journal of the American Medical Association (JAMA) published a proposal for controlling conflicts of interest between PMAs and their relationships with industry.² It described several underlying principles and premises, and provided some valid suggestions. Most of these are intuitive. For example, most physicians would agree with the following:

1. “The pharmaceutical and medical device industries make important contributions to medical progress.” No one in the highly technology-dependent field of electrophysiology can argue against this. The pacemakers and defibrillators we implant, the tools that we use during catheter ablation procedures, and the antiarrhythmic drugs that we prescribe have all been developed by industry. Often these devices were found to be effective through industry-sponsored clinical trials involving practicing electrophysiologists.

2. Physicians should fully disclose financial relationships with industry. Full disclosure and transparency is now widely endorsed. However, “resolving issues of conflict of interest is not best accomplished by avoiding all relationships.”

3. Physicians should not receive gifts from industry. “Research demonstrates the power of gifts to bias physicians’ choices.” There have been rules against physicians accepting gifts for several years now.

4. “Funds from industry (to PMAs) should be unrestricted.” Physicians are able to easily identify when industry support comes with strings attached.

5. “Physicians and medical societies should avoid marketing industry products.” Academic institutions and physicians who are involved in industry-sponsored educational activities have defined which activities are related to product marketing and should be avoided, and which activities are supported by unrestricted industry funding and are acceptable.

However, the JAMA article makes recommendations to restrict who can serve on PMA Professional Guideline and Scientific Session committees that are unnecessary and fail to recognize that most relationships are legitimate. They state that “disclosure of industry relationships by committee members is not sufficient protection. … At a minimum, PMAs must exclude from such committees persons with any conflict of interest ($0 threshold) involving direct salary support, research support, or additional income from a company whose product sales could be affected by the guidelines.”