UPFRONT

Dollars and Sense

Peter K. Kaiser, MD

“I have yet to see a piece of writing, political or non-political, that does not have a slant. All writing slants the way a writer leans, and no man is born perpendicular.”
— E. B. White

I am a member of the American Academy of Ophthalmology Subspecialty Day Planning Committee, and insuring that the meeting is delivered with minimal bias is a key guiding principle of the committee.

As at previous meetings, in November, we heard several presentations of major clinical trial results from pharmaceutical companies for their key drugs (eg, ranibizumab and aflibercept). The drug companies often produced the presentations that were then delivered by study investigators, who by definition are biased because they received at least research grant support and at most are consultants or even shareholders.

So is this wrong? Could the investigators analyze the data themselves and produce the presentations without any drug company interference? I am not so sure.

It is almost impossible for an investigator to be able to analyze all the data from these massive studies, and most have no ability to produce the graphs and tables needed to deliver the presentations adequately. The legal reviews that these presentations go through at the pharmaceutical companies are stricter than anything we could do as a committee or as a CME provider.

Should a totally unbiased person deliver the presentations instead? This would be a problem too, because unbiased parties would have no knowledge of the studies or how their patients performed in these studies. The presentation would lose a lot and would make the Subday meeting very boring.

So what should we do at future meetings? I am open to any suggestions. The committee has “banned” speakers who could not conform to CME rules and who were overtly biased. But most speakers are able to deliver unbiased presentations despite their obvious bias.

The problem will only be magnified when the Physician Financial Transparency Reports Act (the Sunshine Act) goes into effect. Should we list dollar amounts in the disclosure slides? Should an independent audit be done to make sure all disclosures are listed?

It will be a very interesting year at the major meetings because we will all know how much a speaker has been paid by the company about which she or he is speaking.

[Editor’s note: I am a consultant for numerous pharmaceutical companies, so I am also biased in this discussion, having delivered several presentations on major clinical trial results.]