RX: PROFESSIONAL INTEGRITY (prn)

To the Editor:

I've just been looking through the October 2005 issue of The Journal of Clinical Hypertension (JCH), and I wanted to praise your excellent and long overdue comments on the sponsorship of “educational talks.” ¹ Your statements were all correct, but I take some issue with the priority you assigned for responsibility for the current state of affairs.

The third from last paragraph about the responsibilities of the “educators” should have been the lead and emphasis of the piece. The evolving distortion of the process that we have all seen over the past 25 years has occurred because of the complicity of the speakers, many of whom are professors, who “profess” to answer to a higher standard! Of course, it also represents the changing orientation of management and standards in the drug industry, about which we hear almost daily in the media.

I realize the difficulty of fully stating opinions that may not be popular in some circles, but which many of us have shared. However, we really must stand up to the distortion of the impartiality of the professorate. He who pays the piper should not call the tune.

When these industry‐sponsored educational programs began (hypertension was in the vanguard of this phenomenon) over 35 years ago, there were no specified agendas other than to discuss the etiology, evaluation, and treatment of hypertension from a global standpoint. Drugs were discussed by their class, mechanism of action, and efficacy—without concentration on any one product. Industry, while providing funds for the program, did not specify the topic or agenda, and certainly not the specific recommendation for one of their products. With time this attitude changed, initially with subtle innuendo, then evolving into blatant, even brazen attempts to dictate lecture content. The process has even evolved to the status where nonexperts and even experts are provided with prescripted, “canned” talks with accompanying slides to produce poorly disguised sales pitches.

While the marketing departments in industry may consider this a coup, it actually may be counterproductive, judging from comments that I routinely received after lectures in the past. The comment was usually along the lines of “I'm so glad that you didn't give us a sales talk on one of the medicines.” Thinking physicians in practice recognized when the process was being abused, and they resented it.

I could certainly relate a few well chosen personal experiences to document the erosion of academic propriety and the attempts by industry to subvert the process of honest discourse. I am certain that you have more tales to tell.

Perhaps it would be worthwhile to consider a roundtable discussion with some of the old “war horses” to discuss this problem at a future JCH roundtable. I know it would make for interesting reading, and it might temper the trend that has been so painful to many of us. The solution can only come from within our profession, and the antidote is an old medication known as integrity.—Karl Engelman, MD, Hilton Head Island, SC

(Editor's note: Dr. Engelman is retired and was the former chief of the Hypertension Section at the University of Pennsylvania School of Medicine, Philadelphia, PA.)