Minimizing Undue Commercial Influence at Scientific Meetings…Or Is That Really a Problem?

Is there an excessive commercial influence at scientific meetings? That question has been asked in various ways in the last several years, and one of the most recent was by Eduardo Bruera, MD, Chair of the Department of Palliative Care and Rehabilitation at the University of Texas M. D. Anderson Cancer Research Center in Houston, who, with two coauthors, in a letter in the Journal of Clinical Oncology (2002;20:1707–17008), described an increased occurrence of drug trade names in scientific meeting abstracts. Dr. Bruera and his colleagues—Carla Ripamonti, MD, of the National Cancer Institute in Milan (the first author), and Catherine Sweeney, MD, also of M.D. Anderson—contend that if this trend continues, it will damage scientific discourse at such assemblies. They proposed three steps that they said could halt the trend (see box). Not everyone agrees, however, that the consequences of the trend will be so dire—or that the motivation behind it is as sinister as Drs. Bruera, Ripamonti, and Sweeney seem to portray it to be. In an interview, Dr. Bruera said that over the last few years he has noticed more and more authors include drug trade names in meeting abstracts and presentation titles, rather than the generic names, which were previously favored. To determine whether this trend was real or a misperception on his part, Drs. Ripamonti, Sweeney, and Bruera surveyed the abstracts from the last two World Pain Congresses, The Congress is the largest meeting of the International Association for the Study of Pain (IASP) and takes place every three years. Increase in Both Percentage & Number of Times There was in fact a significant increase in both the percentage of abstracts containing brand names and the number of times a brand name appeared in an abstract between the 1993 meeting and the most recent one in 1999. This was particularly true, the authors said, for more expensive patented drugs, such as the time-release opioids. Dr. Bruera expressed concern that this increased usage of drug trade names may not simply be a change in reporting style, but may reflect a substantive change in the research underlying an abstract. “The question is, are people simply doing the same kind of work and research and trying to publish the same papers as before but now they are very aggressive about using the trade names?,” asked Dr. Bruera. “Or is the fact that they are making it into the abstract book or body of the talk with their trade name the motivation to conduct some short-term or short-sighted study? I don't know that we have data to support one or the other [of these questions] at this point.” But given the emphasis with which he raised the point, he clearly considers this potential a problem that academic societies need to prevent from happening. The Editor-in-Chief of the American Society of Hematology's journal, Blood, Kenneth Kaushansky, MD, Chair of the Department of Medicine at the University of California, San Diego, said he is not convinced that the problem is as serious as Dr. Bruera's group thinks it is. (ASH chose to have Dr. Kaushansky respond for this article.) “The writers think there is something very sinister going on, but I'm not sure that there is a big conspiracy by drug companies to stick their names in the abstracts,” Dr. Kaushansky said. As for whether or not the pharmaceutical companies are sponsoring research just to get their trade names listed in the abstract books and journal articles, Dr. Kaushansky said, “I think that is ludicrous. It is a lot easier to buy an ad than it is to sponsor a trial.” He admits there are some problems with industry-sponsored research, but said he just doesn't think the ones addressed by Dr. Bruera and colleagues are at the top of the list. Taking Action Despite dissimilar views on the intent behind the increased use of drug trade names, Dr. Kaushansky and Dr. Bruera do agree that the use of brand names is not in the best interest of science. In fact, two of the three recommendations made by Dr. Bruera and his coauthors are already included in the instructions to authors of several major journals, including Blood and the Journal of Clinical Oncology, ASCO's journal. The letter in JCO recommended the use of generic rather than trade names. Dr. Bruera conceded that It might be beneficial to the reader to include the trade name and manufacturer once in a paper, in the Methods section, perhaps, but that that information does not need to be used extensively throughout the text.Figure: Eduardo Bruera, MDFigure: Kenneth Kaushansky, MDFigure: Daniel Haller, MDPolicy Already Used in Blood & JCO This is the policy currently used in both Blood and JCO. However, JCO's Editor-in-Chief, Daniel G. Haller, MD, Associate Chief for Clinical Affairs in the Hematology-Oncology Division at the University of Pennsylvania Health System, isn't as hard-nosed about never using a trade name as Dr. Bruera's group. (As with ASH, ASCO asked that questions about the issue be referred to Dr. Haller.) “I think on the whole they are correct,” Dr. Haller said. “I think the intent of what they reported is correct— scientific publications are not advertisement. But, science is education, and I don't want articles to be so opaque that people have to go into the literature to find out what an article is about.” Therefore, sometimes it is appropriate to use the trade name, he said, and JCO typically includes the trade name and manufacturer in brackets with the first reference to the drug in a paper's Introduction for this reason. Furthermore, another recommendation by Drs. Bruera, Ripamonti, and Sweeney that authors disclose any potential conflicts of interest is already standard policy for these two journals, and both Dr. Kaushansky and Dr. Haller said they think it is important information for readers to weigh when deciding the value of a work. Two Types of Studies? The third suggestion put forth by the authors, however, is more controversial. They would like to see the scientific program at meetings balanced between large, methodologically impressive studies, which due to their expense are likely to be industry sponsored, and smaller more novel studies, which might be less methodologically impressive but are of high clinical relevance. Dr. Bruera explained that this recommendation is important in order to maintain a variety of subject matter at scientific gatherings. “Do we allow a fourth or fifth comparison between these drugs or a retrospective study that shows something intriguing and relevant?,” he asked. He admitted, however, that this effort comes down to a judgment call and may be difficult to implement, but thinks it is nonetheless important enough to consider. Dr. Kaushansky, who has sat on ASH's Annual Meeting Program Committee over the past several years, described such a recommendation as “micromanagement.” “I think this approach is wrong because you would be putting artificial constraints on choosing the best papers for publication. “We think scientific excellence should be the only criteria for choosing papers,” he continued, referring to the ASH Program Committee. “If there are two studies, one with 3,000 patients versus one with 11 patients, which is going to impact clinical practice more? The one with 3,000 patients, because there is power in numbers. If the study with 11 patients was treading on new ground, then they would get a lot of brownie points for novelty. Again I think the only criteria should be scientific excellence—and that takes in both of those things.” Dr. Haller concurs: “I don't think you should look at research as pharmaceutical versus non-pharmaceutical. You should look at quality—If the best studies are all by pharma, so be it. It tells you they are doing a good job.” Furthermore, he pointed out that some societies remove the authors' affiliations from abstracts before sending them to the scientific program committee to limit bias toward better-known institutions and toward financial sponsors of the meeting. IASP's Response As for the World Pain Congress, the Chair of the Scientific Program Committee for the next meeting (August 17–22 in San Diego), Jonathan Dostrovsky, PhD, Professor of Physiology and Director of the Program in Neuroscience at the University of Toronto, said that he thinks the use of generic names as opposed to trade names is important. “It is too late to be addressed for this upcoming Congress, but it is something that the IASP Council and the Scientific Program Committee should discuss and consider for the next Congress,” he said. The Association already requires full disclosure of both author affiliation and study sponsorship, Dr. Dostrovsky added. He chose not to comment, however, on Dr. Bruera's third suggestion of trying to maintain a balance between clinical relevance and methodological power when choosing papers for presentations. 3 Suggestions In their JCO article, Drs. Bruera, Ripamonti, and Sweeney made three suggestions to prevent what they said was an escalating use of trade names in the scientific content of medical conferences: ▪ The use of trade names should not be allowed in the title or text of abstracts and should not be allowed in any scientific presentations during scientific meetings as well as during teaching sessions or CME programs, even if a drug company sponsors them. When it is needed to identify the source of the drug, it is enough to provide the name of the drug with the manufacturer in brackets. ▪ Pharmaceutical affiliation of the authors or sponsorship for the study or lecture should be mandatory in all submitted abstracts, in CME programs, and in grand found meetings. ▪ There should be a balance between pharmaceutically sponsored and nonpharmaceutically sponsored scientific research in every meeting and educational program to avoid projecting false-positive information about the effectiveness of certain drugs or interventions that are likely to be more costly. Do You Want to Continue Receiving OT? If this issue contains a business reply card on the front cover, we still need to hear from you! Please return the card today to ensure uninterrupted delivery.

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