I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease.
Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest.
Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was reliably followed by all presenters … in the following manner: “Here are my disclosures” — PowerPoint slide flashes on screen with a list of pharmaceutical/device companies. Yet, by the time the speaker finishes speaking those four words, the slide deck has already advanced to the next slide. I, and my fellow audience members, didn’t even have enough time to read the disclosures, let alone process them.
Now, I have no problem with pharmaceutical sponsorship of biomedical research. Nor do I wish to criticize physicians for accepting industry funds. However, I do feel strongly that all such financial relationships must be completely transparent.
Personally, I feel that transparency is not achieved by quickly flashing a slide in front of an audience. No, transparency requires not only that each speaker’s financial relationships be read out loud, but that any connection between these relationships and the subject matter being discussed should be explicitly stated. We as audience members should not have to connect the dots and look up which pharmaceutical companies manufacture which drugs; rather, we should expect that these connections will be made for us.
What would such transparency look like in practice?
For example, if a speaker is giving a talk on novel oral anticoagulants for use in atrial fibrillation, the talk should begin with the following statement:
Today I’m going to talk about the use of oral direct thrombin inhibitors and Xa inhibitors. I would like to disclose that I receive consulting fees from Boehringer Ingelheim, maker of dabigatran, Bayer, maker of rivaroxaban, and Daiichi Sankyo, maker of edoxaban.
That’s it. Short and sweet. But now, when the presenter proceeds to discuss the clinical use of dabigatran, rivaroxaban, and edoxaban, I know that he has a financial connection to these drugs.
There has been great progress towards transparency recently, including the passage of the “Sunshine Act,” which mandates that drug and device manufacturers participating in federal health programs publicly report payments to physicians and teaching hospitals. Yet, such transparency will only be meaningful if it is presented clearly, and in a manner easily understandable by the public.
Explicitly stating (out loud) financial relationships between speakers and the topics they discuss would be a good start.