Letters to the Editor
Conflicts of Interest: Is the AAN Policy Reflective of Member Preferences? The AAN Responds
Even as someone who is very careful at watching out for my own conflicts of interest, of avoiding chumminess with pharmaceutical representatives, I feel strongly that I should not attempt to proscribe the behavior of others. This perhaps is my biggest complaint about the recent AAN policy. (See “A Disclosure from the AAN: An Updated Policy on Managing Financial Conflicts,” April 5, http://bit.ly/ITu5sR.)
How is it that a group of AAN members can pretend to speak for the AAN as a whole? I never endorsed these members or their paper. Maybe this should have come to some absolute vote, which would also be published, as to how many members agree, how many disagree, how many have abstained from an opinion.
The starting point to having a strong opinion, and of making that opinion known, is to apply its maximum strength to one's own behavior. I do not see a de facto exemption for paid advertising in Neurology Today or in the journal Neurology. I note that finally we have recently seen a reduction in the prominence of ads in Neurology. They are no longer interspersed between articles or printed on heavier paper than the rest of the journal. Yet still they make claims or carry tag lines, which we might be kind to label as irrational exuberance.
One of the headlines in the April 5 Neurology Today is “Novel Clot Retrieval Device Outperforms Merci for Acute Ischemic Stroke” [http://bit.ly/HBa7TD]. From this, I read an endorsement of these proprietary products, and an apparent preference. The commentary inside matters little, since it visually had no similar prominence.
I do not endorse an absolute end to proprietary support in education, either on a personal or organizational level. If we did take this approach, we would say that it is okay for company X to support the journal, support the AAN meeting, but they cannot be identified by name, nor can their products be connected with any journal or meeting support. If we are going to endorse a complete elimination of conflict of interest, then it must be complete, even if it jeopardizes the life of the journal or the annual meeting.
Please stop being hypocritical. You cannot point a finger at conflicts in others as you accept handouts yourselves. I don't see some greater public good from accepting advertising revenues than individual doctors going to pharmaceutical-sponsored educational dinners, or academic faculty members accepting honoraria for speaking at such events.
Gregory Pittman, MD
THE AAN RESPONDS:
A task force of AAN members, representing a wide range of AAN board of directors, committee, section, and individual practice experience, developed the recently amended AAN policies referenced in the Neurology Today article and explained in the March 6, 2012, Neurology article.
Their report, which served as the basis of the amended policies, was presented to several AAN committees, the board, and the membership via the 2010 Ethics Colloquium. With this policy the AAN is fulfilling a critical function of a medical association: developing and disseminating policy and position statements on behalf of its membership, for the benefit of the members and those our members serve.
The AAN is an association organized and led by its members. The slate of nominees for service on the board is presented to the membership for approval. Members are welcome to join one or more AAN sections or nominate themselves or others for committee or task force appointments. Utilizing this structure, key thought leaders are identified to develop clinical practice guidelines, practice parameters, ethical statements, and professional codes to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.
As an organization, the AAN believes a complete ban on industry relationships compromises mutually beneficial collaboration. However, strict regulation of conflicts is necessary, with elimination, management, and/or disclosure as appropriate. Members serving in various leadership roles within the AAN make this determination, and this responsibility is not without its challenges. Each context where industry involvement occurs or is requested is reviewed. As an example, the exhibit hall and advertising within AAN publications are deemed appropriate for industry, both because members and the public can identify the messaging as being from industry and the AAN does not see value in severing industry's ability to disseminate information that may assist members in better serving their patients.
The AAN strives to achieve appropriate management of conflicts to ensure its positions, publications, and resources are unbiased and transparent. How this is accomplished as an organization is constantly reviewed and evaluated. From an individual perspective, the physicians in the article describe the environment of increased scrutiny of physician-industry relationships, to assist others in their practice. Apart from AAN organizational policy, industry-developed codes govern industry-sponsored meals, giveaways, etc., institutions may have their own conflicts of interest policies, and state and national laws govern individual amounts given to physicians from industry annually.
Bruce Sigsbee, MD, FAAN
President, American Academy of Neurology