Industry Support Of Societies Under Fire

An editorial accompanying a JAMA thyroid drug study criticized private-sector funding of professional associations. A recent editorial in JAMA-Journal of the American Medical Association that detailed the events surrounding the suppression of a pharmaceutical study has drawn attention to the relationship between scientific professional societies and sponsorship by private companies (D. Rennie, JAMA, 277:1238-43, 1997). In its April 16 issue, the journal published a long-subdued study that showed that a popular thyroid drug called Synthroid was no more potent than less costly formulations (B.J. Dong et al., JAMA, 277:1205-13, 1997). The editorial, which ran in the same issue, decried the growing trend of industry-sponsored research and called for professional societies to reexamine their relationship with the private sector. Yet society officials point out that there are already many conflict-of-interest safeguards in place. RESTRICTIONS: JAMA deputy editor Drummond Rennie contends that to maintain credibility, societies should set limits on contributions from individual corporate sponsors. In the editorial, JAMA deputy director Drummond Rennie wrote that Knoll Pharmaceuticals Co. of Mount Olive, N.J., had fought against publishing the research findings of a team headed by Betty Dong, a professor of pharmacy at the University of California, San Francisco. Dong did, however, sign an agreement with Knoll-the sponsor of the research and Synthroid's maker-stating she would not publish her work without the firm's permission. Earlier this year, Knoll finally okayed publication of the paper; the work in question had been completed seven years previously. In the same issue, JAMA also published a letter from Knoll president Carter H. Eckert expressing regret over the situation (277:1200, 1997). Rennie criticized the administration of UC-San Francisco as well as the American Thyroid Association (ATA) for not taking up the cause of academic freedom when Dong was struggling with Knoll to publish her results. Rennie also chided the thyroid association for not imposing limits on its ties with industry, especially Knoll. "What was so striking about this case was the massive and highly unusual dominance of one drug in the market-Synthroid-and the massive dependence of societies, not just the American Thyroid Association, on the money from the company whose biggest product is Synthroid," Rennie tells The Scientist. In a faxed statement to The Scientist, Knoll wrote that it is "one of many companies that support professional societies conducting educational programs in the field of endocrinology. . . . Knoll primarily supports these societies in the form of unrestricted educational grants to fund . . . accredited programs that are directed and run by the respective societies to ensure objectivity, independence, scientific rigor, and balance. We consider the amount of funding provided to professional societies to be proprietary information." Rennie believes that societies' reputations could be at stake. "I feel that the more one receives commercial money-either as an individual or a society-the less one is able to judge or make decisions or make pronouncements on issues; the less one is able to appear credible," he says. "Societies that take a lot of industry money cannot really expect the public to find them credible if the things that they pronounce [have] any bearing whatsoever [on] the products of the industry. This may be completely unfair, but it's the way we all are when we judge the action of others." The nature of the association between societies and the private sector can take many forms, including sponsorship of special symposia and corporate affiliate memberships. Society executive directors draw a distinction between groups oriented toward basic research and those focusing on clinical medicine. "There is no doubt a differential in external funding between traditional basic science societies like the American Physiological Society [APS] vs. those that have more of a clinical tie, like the American Thyroid Association," says Martin Frank, executive director of the Bethesda, Md.-based physiological society. Since members of more clinical medical societies dispense drugs or conduct research on drugs, they naturally have a more direct link to industry than do members of basic scientific societies. EYES WIDE OPEN: Association of American Universities' Cornelius J. Pings states that corporate-professional society relationships shouldn’t be "entered into lightly." Although Cornelius J. Pings, president of the Association of American Universities (AAU) in Washington, D.C., declines to "make a judgment about what professional societies ought to do," he states that these relationships should not be entered into lightly. Parties, he says, shouldn't "just lumber into this, as is too often the case." AAU doesn't have an official policy statement on such alliances, but Pings notes that the general topic of industry-academic relations is one AAU will be taking up soon. "I'm not saying that members of the American Thyroid Association are bad people," contends Rennie. "I'm just saying that they got themselves into an ethical hole, probably unwittingly. Even if they are performing perfectly judiciously, and well-and in every case for the benefit of patients-how can the rest of the world believe it if they get such a massive donation [from one source]?" He contends that he doesn't have a problem "if corporate money comes from a lot of different sources, doesn't relate to the sponsor's product, and comes with no strings attached." Representatives of professional societies contacted by The Scientist state that the funds from their industry sponsors fulfill Rennie's criteria. He stated in his editorial that ATA receives "more than 60 percent of its commercial sponsorship from Knoll." E. Chester Ridgway, president of ATA and a professor of medicine at the University of Colorado Health Sciences Center, disagrees with Rennie's figures. "The significant thing that [Knoll] gives to the [ATA] meeting is one evening program. All corporate sponsorship is 20 percent. Of that 20 percent Knoll contributes 75 [percent] to 80 percent. The rest is from dues." In its statement, Knoll responded to claims made in Rennie's editorial. "Given the great care that is taken by professional societies and Knoll to ensure objectivity and independence in the educational programs we support, we take exception to Dr. Rennie's implication that funding legitimate educational and scientific endeavors, which benefit health professionals and patients at large, in any way compromises the quality of the programs or independence of the societies." GUIDING PRINCIPLES: Scott Hunt points to standards set up by the Accreditation Council for Continuing Medical Education as a shield against conflict of interest. Despite Rennie's criticism of the thyroid association, he says, "I pat the association on the back for addressing the issue openly" at the ATA business meeting during the national conference in San Diego in October 1996. He wrote in his editorial that the association had the "courage to debate whether to write to Knoll to allow publication of the paper." But, he continued, "The motion to write the letter was narrowly defeated. . . . An outsider is left with the sad impression that the ability of the association to influence these events by speaking with moral authority was weakened by its heavy dependence on money from Knoll." "The discussion was very lively on both sides of this issue about whether to write a letter to Knoll of censure," recalls Ridgway. "That's what the meeting was about and that's what [Rennie] means by moral authority-censure." According to Ridgway, two points explain why the ATA membership voted the way they did. One was that Dong signed a contract that was legally binding. "What was the ATA doing censuring a company when the investigator had signed a legal document?" he asks. The second issue, he states, was that members didn't want to pass judgment on a paper they had never read. In his editorial, Rennie proposed a solution to perceived credibility problems: He suggested that "if academic societies wish to retain any credibility, they should consider making sure that no individual sponsor can contribute more than 5 percent of the total." "I think that that's an artificial structure," says Scott Hunt, executive director of the Bethesda, Md.-based Endocrine Society, which represents both researchers and clinicians. "The fact is, if independence is maintained by the society, there shouldn't be this difficulty." He points to the standards for commercial support set up by the Accreditation Council for Continuing Medical Education (ACCME) as a shield against conflict of interest. The Chicago-based council conducts a voluntary accreditation program for institutions and organizations that provide continuing medical education. Within ACCME's "Essentials, Guidelines, and Standards" document is the four-page Standards for Commercial Support of Continuing Education. According to Kathy Johnson, the council's manager of accreditation services, the purpose of these standards "is to prevent promotional or biased education." For example, one standard states that commercial supporters of educational activities "shall not control the planning, content, or execution" of the event. "Any time we get a contribution for a specific type of scientific event, it has to fulfill ACCME requirements," says Hunt. "They accredit our continuing-education programs, which all of the contributions [from industry] are pretty well associated with. For example, if Knoll wanted to sponsor a symposium at an Endocrine Society meeting, they would have nothing to do with choosing the chairman of the program or the speakers." BASIC DIFFERENCE: "There is no doubt a differential in external funding between basic science societies vs. those that have more of a clinical tie," says physiological society official Martin Frank. Directors of professional societies that represent basic researchers say Rennie's suggestion for maintaining a credible appearance doesn't really apply to their situation. The American Physiological Society's Frank says there's "no way" that the society gets 5 percent from any one source in industry, let alone one sector. FAVORITE CHOICE: Corporations sponsor everything from travel awards to educational activities, but supporting symposia is the most popular, says ASCB's Elizabeth Marincola. "A typical meeting costs about $1 million, and we never got a gift that approached 5 percent from one donor," notes Elizabeth Marincola, executive director of the American Society for Cell Biology (ASCB) in Bethesda, Md. ASCB does accept educational funds from industry and has corporate members who lack voting privileges. "Scientists can join ASCB for $95. If a corporation wishes to maintain some good will with a society and keep their name visible on a list of corporate members, they may become corporate members for $1,000. But they can't influence what we do; they can't even vote." Generating some income from industrial sources seems to be the norm for professional societies. "My guess is that the association is common," says Rennie. "And it's natural and right for it to be common because companies are dependent on good science and they do encourage it and give money for it." Society representatives interviewed by The Scientist state that most of their corporate funding goes to educational activities like symposia, travel grants, and public-education initiatives. "Most of the [basic science] societies, including APS, have what we call sustaining associate programs, or corporate associate programs, in which corporations usually make a donation as if they were a member of the society, probably in the range of $1,000," says Frank. "We have about 35 sustaining associates, so that's not a hell of a lot of money. The other source of revenue from corporations comes in the form of support for scientific meetings. Generally the support is in the range of $1,000 to $2,000 [per company], nothing significant." "Various companies fund several of our scientific awards-honorariums plus travel expenses," notes Kay Croker, executive officer of the American Society for Pharmacology and Experimental Therapeutics (ASPET) in Bethesda, Md. "But they play absolutely no part in the selection of individuals, nor do they play any part in the committee that selects the winner." ASPET also has corporate members. "This money is used for certain projects that we feel would not be a conflict of interest from this source, such as educational programs," adds Croker. EVEN-HANDED: "No one company is off the chart with regard to their level of funding," notes Barbara Munday of the American Digestive Health Foundation's industry support. Marincola says that corporations sponsor some events at the ASCB annual meetings. "The most popular choice is the symposia," she notes. "We have been put in the situation where a company that's sponsoring research would like the opportunity to have their scientists participate in a symposium that they're sponsoring. That is, by policy, declined completely. We will decline a gift if there are any strings attached along those lines. There's no opportunity for a company-whether or not they've given us money-to influence the scientific program of a meeting. What they can get in return for their sponsorship-if you will-is recognition of their sponsorship." Robert Rucker, president-elect of the American Society for Nutritional Sciences (ASNS) and a professor of nutrition and biological chemistry at University of California, Davis, asserts that ASNS has a conservative policy toward accepting funds from industry. ASNS's corporate sponsors primarily fund activities associated with the society's annual meeting. "There's no reference or endorsement inferred or implied. All of this money comes without obligation." The Bethesda, Md.-based American Digestive Health Foundation (ADHF) is an umbrella group for three professional societies-the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the American Association for the Study of Liver Disease, all of which represent clinicians and researchers. Barbara Munday, ADHF's vice president, says that funds from industry are used for the Digestive Health Initiative, ADHF's education and research effort. "No one company is off the chart with regard to their level of funding. The educational messages that come from this initiative are guided by science, not sponsorship, through the oversight of a scientific advisory board," she adds. The many safeguards established within organizations like ADHF and ACCME are indicative of the fact that industrial involvement in professional societies is commonplace. But, as Rucker points out, the demographics of academic research societies are changing. "With more and more people being employed in industry-because that's where the jobs are-how to deal with industry will be an increasing challenge."

Industry Support Of Societies Under Fire

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