BLOGSCAN - On the APAs "Long Traditions and Established Practices"

On Alison Bass' blog, this post discussed the ongoing US Senate probe of, among other things, the American Psychiatric Association's relationships with pharmaceutical companies. In a memo to its members, APA President Nada Stotland, seemed more concerned about the questioning of "long traditions and established practices" than about whether the questions were valid. In a final twist, although the APA publicized the existence of the memo, its content is not available to the general public.

Post Title → BLOGSCAN - On the APAs "Long Traditions and Established Practices"

Fat Chance: Conflicts of Interest and Calorie Counting

Stephanie Saul in the New York Times, and Karl Stark in the Philadelphia Inquirer have covered the curious story of the downfall of the president-elect of the Obesity Society. Last month, Ms Saul set the stage,

New York City’s new rules for menu labels at chain restaurants have set off a food fight among the nation’s obesity experts.

Most support the theory of the city’s health commissioner that forcing chain restaurants to list the calories alongside menu items — flagging that a Double Whopper With Cheese has 990 calories, for example — will make patrons think twice about ordering one. The rules are set to take effect at the end of March.

There is a countertheory, however, set forth by Dr. David B. Allison, the incoming president of the Obesity Society, a leading organization of obesity doctors and scientists. An affidavit he recently submitted to the United States District Court for the Southern District of New York has ignited a controversy within his organization.

In the filing, Dr. Allison argues that the new rules could backfire — whether by adding to the forbidden-fruit allure of high-calorie foods or by sending patrons away hungry enough that they will later gorge themselves even more.

It might be only a scientific debate among nutrition experts, except for the fact that Dr. Allison was paid to write the document on behalf of the New York State Restaurant Association, which is suing to block the new rules.

Dr. Allison’s role in the debate has angered some members of the Obesity Society, setting off an e-mail fury since word of his court filing began to circulate. Some have pointed to Dr. Allison’s other industry ties, which have included advisory roles for Coca-Cola, Kraft Foods and Frito-Lay.

Many of the group’s 1,800 members are “completely mad that a president-elect of the Obesity Society, an organization that cares about obesity and cares about healthy eating, wants to hold back information from people that helps them make healthy choices,” said Dr. Barry M. Popkin, a member of the organization, who is director of the Interdisciplinary Obesity Center at the University of North Carolina, Chapel Hill.

Dr. Allison, a professor of biostatistics and nutrition at the University of Alabama, Birmingham, is scheduled to start a one-year term as president of the Obesity Society in October. He has defended his affidavit. In a telephone interview, he said he did not take a position for or against menu labeling in the document but merely presented the scientific evidence that the labeling might deter over-eating but might not and, in fact, might be harmful.

He also defended his work for the restaurant industry, but would not disclose how much he was paid for his efforts.

“I’m happy to be involved in the pursuit for truth,” Dr. Allison said. “Sometimes, when I’m involved in the pursuit for truth, I’m hired by the Federal Trade Commission. Sometimes I help them. Sometimes I help a group like the restaurant industry. I’m honored that people think my opinion is sufficiently valued and expert.”

The executive vice president for the restaurant association’s metropolitan New York chapters, E. Charles Hunt, said that Dr. Allison was retained by the association’s lawyers. “Obviously, a lot of it was in favor of our position,” Mr. Hunt said, “although he didn’t come right out and say that.”

So this sounds like yet another story about conflicts of interest, and their possible effects influencing the publicly expressed opinions of a prominent academic. As usual, the conflicted party angrily denied that his financial relationships could have affected his scientific judgment. As we have noted before, this is undoubtedly a sincere belief, but psychological evidence and common sense suggests that having financial ties to organization x may influence one to take positions in line with organization x's interests, even if these influences do not reach conscious thought.

The variant here seems to be that the academic had a financial relationship not with a drug, biotechnology or device company, the usual suspects, but with an association of restauranteurs.

But wait, Mr Stark added more in his story in the Philadelphia Inquirer,

The relationship between academic researchers and industry is a front-burner issue in many fields. Several congressional inquiries are looking at drug-firm support for the American College of Cardiology, the national cardiology group, and the American Heart Association.

Compared with those groups, the Obesity Society, based in Silver Spring, Md., would seem like a tiny outpost with its $2.1 million budget. But the group's 1,800 members include many influential researchers, physicians and dietitians.

The society relies heavily on industry money, raising about $1 million in the last year from various companies, said Morgan Downey, the group's executive vice president. The biggest corporate donors were drugmakers sanofi aventis, GlaxoSmithKline and Allergan as well as the health-care conglomerate Covidien, he said.

About $230,000 of the corporate money funded a conference in September for health advisers to presidential candidates, Downey said.

Fast forward to this week, when Ms Saul reported in the New York Times that Dr Allison is giving up his leadership position for the Obesity Society,

A dispute over food industry influence has resulted in the resignation of the incoming president of the Obesity Society.

Dr. David B. Allison, who was to take over the society, a national group of obesity doctors and researchers later this year, submitted his resignation from that position on Friday.

So what happened? Did the Obesity Society cast out a leader because he had conflicts of interest that interfered with his ability to advance science, education and clinical practice? Or did the Obesity Society cast out a leader because he was aligned with commercial interests opposed to the commercial interests that provide most of the society's support? That is, was he cast out not because he had conflicts of interest, but because he did not have the same conflicts of interest as the society?

Who can tell?

Once again, this case is an illustration of the pervasiveness of conflicts of interest affecting health care organizations. It also shows how the pervasiveness of such conflicts sometimes makes it impossible to discriminate debates about science and health policy from the claims of conflicting pitchmen.

Full disclosure of these conflicts beforehand would at least have given warning that the nature of the debate was ambiguous.

But to figure out the best answer in the current policy debate, that is, whether it really is a good idea to have legislation to put calorie counts on restaurant menus, would really require the input from people who are not paid by either restauranteurs, or those selling obesity treatments. Fat chance that will happen soon.

Post Title → Fat Chance: Conflicts of Interest and Calorie Counting

Why Dont' Physicians Do What They Say They Ethically Ought to Do?

The Annals of Internal Medicine just published a major study that contrasted physicians' attitudes toward professional norms with their self reports of whether they acted in conformity with these norms. [Campbell EG, Regan S, Gruen RL et al. Professionalism in medicine: results of a national survey of physicians. Ann Intern Med 2007; 147: 795-802. Link here.]

In brief, the authors developed a survey which asked physicians whether they agreed with various professional norms organized according to the 2002 ABIM/ ACP/ ESIM Physician Charter. They also asked them about whether they acted in conformity with these principles in terms of their recent actions, or in responses to scenarios. Physicians surveyed were primary care practitioners (family medicine, general internal medicine, and pediatrics), cardiologists, anesthesiologists, and general surgeons. The overall response rate was 52%.

In general, large majorities of physicians agreed with the ethical norms. How often they reported acting in agreement with these norms varied. In particular, nearly all physicians reported treating patients honestly (less than 1% reported telling a patient's family member something untrue in the last 3 years, 3% reported withholding information from a patient or a family member.) However, although 96% agreed that "physicians should put the patient's welfare above the physician's financial interests," 24% would refer a patient to an imaging facility in which the physician was an investor, without revealing this conflict of interest.

Some commentators suggested that external pressures may prevent physicians living up to the standards they themselves have endorsed. For example, physicians interviewed in a Washington Post article suggested that the current emphasis on patient satisfaction may conflict with the physician's ethical obligation to avoid wasting resources when a patient demands an unnecessary but not clearly harmful test. The Congressional Quarterly reported quoted the CEO of the Federation of State Medical Boards saying that physicians "were penned in by the American the health care system, fighting giant bureaucracies while fearing legal action if they make a mistake."

However, there was not much more discussion of the sorts of external pressures that might push physicians to forsake their values. Yet readers of Health Care Renewal might be able to come up with more examples.

For example, consider the pressures on young medical school faculty, who are under tremendous pressure from their academic leaders to become "taxpayers," i.e., people who bring in more money from external funding sources than they consume (See this post, in which the Dean of a prominent medical school ranked such "taxpayers" above all other faculty.)

Since government and foundation research support is tight, this leads many faculty to seek research support from pharmaceutical, biotechnology, and device companies. Once they get such support, they may find it hard to turn down offers of consulting positions, speakers' honoraria, advisory board positions and the like from such companies. Spurning such positions may cost them their research support. And their academic superiors often set the example that it is fine to accept such payments. (See this post about the prevalence of such financial arrangements among medical school department chairs.) Under these circumstances, preaching to young faculty about conflicts of interest seems to be just adding insult to injury.

I am most reminded of an article about business ethics we discussed back in July. The theme was that business students understand ethical principles, and know what they ethically ought to do. The problem is that they have trouble actually doing it.

The new article by Campbell et al also suggests that physicians know what they ethically ought to do. They thus don't need new statements of ethical principles, or more instruction about what they ought to do.

Instead, physicians need to focus on the discrepancy between what they know they ought to do and what they actually do.

Some of these discrepancies no doubt arise from their own human failings.

But absent in most of the current discussion is the enormous pressures physicians feel, often from leaders of powerful organizations with strong (usually economic, sometimes political or ideological) vested interests that may conflict with the admirable values embodied in the Physician's Charter.

It's easy to say that individual physicians always ought to do the right thing, regardless of external pressure. Maybe the individual physicians who feel uncomfortable being pressured into doing the wrong thing might get better organized to resist this pressure.

It would be even more helpful if medical and health care leaders could actually support physicians who want to do the right thing. Given that many medical and health care leaders have vested interests that push them in opposite directions, they may not jump at this opportunity.

Post Title → Why Dont' Physicians Do What They Say They Ethically Ought to Do?

BLOGSCAN - More on Collaborating with UnitedHealth for the "Advanced Medical Home"

A number of medical/ health care bloggers have kept at the story of various medical societies' (including the AAFP, AAP, and ACP) questionable collaboration on a pilot project for the "advanced medical home" with UnitedHealth (see our post here). Retired Doc's Thoughts first took it up here, and then here continued to ask tough questions in particular about the ACP's role. The Covert Rationing Blog suggested that the pilot project was just managed care with better makeup, and was echoed by KevinMD. Outside of the blogsphere, however, I can't find any discussion of the issue.

Post Title → BLOGSCAN - More on Collaborating with UnitedHealth for the "Advanced Medical Home"

The AMA, "Prescription Data-Mining," In-Store Clinics, and Patients' and Physicians' Interests

OK - I'm back from Geneva and it's time to catch up.

Last weeek, two commentaries from the US east and west coasts slammed the American Medical Association. From the west coast, in the San Francisco Chronicle, Robert Restuccia from the Prescription Project and Lydia Valas from the National Physicians Alliance criticized how the AMA sells information on individual physicians to be used in pharmaceutical company marketing.

One of the less obvious but more intrusive marketing tools is the drug rep's hand-held computer, which contains a detailed profile of your doctor's prescribing history. Armed with the knowledge of each doctor's individual prescribing habits, pharmaceutical sales representatives tailor their pitches to each physician.

The AMA sells information from its physician "Masterfile" to health information organizations that pair the identifying information with prescribing records from pharmacies and sell the whole package to pharmaceutical companies, a practice commonly called "prescription data-mining."

The AMA profits handsomely from this agreement. In 2005, the AMA made more than $44 million from the sale of database products, approximately 16 percent of its budget.

Despite representing less than 30 percent of all U.S. doctors, the AMA keeps identifying information on all licensed physicians - and sells it all. Even so, only 60 percent of physicians surveyed by the Kaiser Family Foundation were aware of the sale of their information. Once told, 74 percent disapproved. Even a survey by the AMA itself found a 66 percent disapproval rate.

A number of policymakers, physician groups and medical societies have come out against this practice in recent years. Leaders include the National Physicians Alliance, the American Medical Student Association, the Vermont Medical Society and the New Hampshire Medical Society. Unfortunately, the AMA has a financial incentive to keep selling this information without regard to how it is being used or the impact it has on patient care and health-care costs.

By continuing to profit from the sale of physician data, the AMA has shown itself to be at best, slow-to-act, and at worst, opportunistic at the expense of professional boundaries. The AMA should put medical ethics before profits and stop licensing its Physician Masterfile for pharmaceutical marketing purposes.

From the east coast, in the Washington Post, Regina E Herzlinger from the Harvard Business School and the Manhattan Institute, criticized the AMA for spending so much effort fighting in-store clinics, but also had more global criticisms.

Physician incomes, when adjusted for inflation, declined 7 percent from 1995 to 2003, while those of professional and technical workers rose. But unlike other professionals -- lawyers, architects, authors and economists -- doctors' work is dictated by the policies of insurers and governments. Increasingly, independent physicians, accountable only to their patients and the Hippocratic oath, have been replaced by salaried doctors who are accountable to the hospitals or insurers that employ them. Salaried physicians are closely policed for productivity, leading to ever-shorter and more numerous appointments per day.

Meanwhile, academic medical journals routinely publish studies that supposedly document the cupidity and ignorance of practicing physicians while lauding the virtues of single-payer health-care systems, such as those in Canada or Britain, in which the physician is paid only by the government. German physicians unhappy with their salaries and work hours under this kind of system had no recourse against their monopolistic bosses but to go on strike last year.

Small wonder that applications to medical schools have declined by nearly 20 percent in the past decade.

You might expect that the AMA would fight the insurers, hospitals, government bureaucrats and ivory tower academics who have diminished physicians' incomes, besmirched their ethical reputations and compromised their professionalism -- but you would be wrong. No, instead, at its annual meeting last month, the AMA declared war on retail medical clinics....

Unfortunately, while the AMA engages in trivial turf warfare, physicians are increasingly forced to become salaried employees of hospitals and insurers and are constrained by recipes for the practice of medicine that are cooked up by government and insurance company bureaucrats.

The cycle is bringing about the imminent collapse of the medical profession -- which gravely endangers our health-care system. We and doctors deserve better advocates.

In my humble opinion, Prof Herzlinger's criticism of the AMA's concerns about in-store clinics is not well justified. (See our last post on such clinics here.) But her more global concerns are substantive. Clearly, a lot of physicians are disgruntled, and as we have posted repeatedly, primary care and cognitive physicians appear to be an endangered species. The increasing domination of medicine by large organizations, including the hospitals and hospital systems and insurance companies and managed care organizations she mentions clearly has a lot to do with these problems. The AMA has, in my experience, at times stood up to the power of these organizations, but not with much effect.

On the other hand, the increasing power of pharmaceutical, biotechnology, and device manufacturers, fostered in part by the complex financial webs these companies have woven to reach individual physicians, academics and academic institutions, and medical associations, also has a lot to do with the problems of health care. The first editorial suggests that the the AMA, representing only 30% of American physicians, but getting 16% of its revenue from the sale of these physicians' data to be used in part by pharmaceutical marketers, may now be too entangled in these webs to always put the interests of patients and physicians first.

For more on the relationships between medical associations and commercial sponsors, see Chapter 12 of the excellent Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry, by Howard Brody, and Kassirer JP. Professional societies and industry support: what is the quid pro quo? Perspectives Biol Med 2007; 50: 7-17 (see our relevant post here).

Post Title → The AMA, "Prescription Data-Mining," In-Store Clinics, and Patients' and Physicians' Interests

"Paying for Access" to Academic and Health Care Leaders at the Tamaya Sustainability Operations Summit

The New York Times just reported on a conference for "university, school, and hospital officials" with an interesting feature. Potential vendors to these institutions were charged very pricy registration fees that guaranteed them one-on-one access to particular officials. In the words of the Times reporter Alan Finder,

The setting for a conference of university, school and hospital officials could not have been more luxurious: a resort in the high desert north of Albuquerque, with a championship golf course, swimming pools, a spa and views of distant mountain peaks.

And for companies wanting to do business with the 200 or so officials attending the gathering, the Sustainable Operations Summit, there was an added benefit.

For $18,500, a vendor was guaranteed 15 one-on-one sales meetings with officials at the conference, held here in June. A company that sent two representatives paid $25,500, with each promised 15 private sessions. The university officials and others who were attending were told flatly that they were required to go to the meetings.

'We’re just organizing an opportunity and a format to encourage discussion and relationships among people,' said Craig Lehmann, a co-founder of the company that organized the event.

CraigMichaels Inc., ... created the sustainability summit. CraigMichaels essentially borrowed the format, which is used by a number of companies promoting conferences that link corporate executives with companies wanting to sell them goods and services, and expanded it to universities and schools.

A year ago, the online publication Inside Higher Ed raised questions about the ethics of the format. But the company has continued its conferences, and many university officials still attend.

The sustainability conference here at the Hyatt Regency Tamaya Resort & Spa, where Al Gore was one of the featured speakers, mixed university, school district and hospital officials who paid roughly $1,000 for three days.

The company gave conflicting accounts of how many half-hour meetings with businesses each official had to attend. Mr. Lehmann, the company president, said at least five were required. Michael P. Owens, the company’s director of production, said there was no minimum number, although people were asked to attend more than one or two.

Each participant was asked beforehand to select at least 10 companies out of the 29 at the event with which he or she would be willing to meet. Vendors were asked to do the same, and CraigMichaels officials then matched them up.

The company’s employees, dressed in blue polo shirts with a CraigMichaels logo and communicating with each other via tiny microphones and earpieces, made sure with a gentle insistence that attendees kept their appointments with the companies, which were promoting solar power or environmentally sensitive roofing, lighting, and heating and cooling systems.

'Why would you let a third party trade on your name and your office?' said Barmak Nassirian, an associate executive director of the American Association of Collegiate Registrars and Admissions Officers. 'I really would have to question if it’s ever appropriate for a third party to charge a fee for an appointment with me.'

Richard A. Hesel, a principal of the Art & Science Group, a marketing consultant to colleges, put it more bluntly: 'This is a form of trying to buy influence. People are paying for access.'

But Susan Jurow, a senior vice president of the National Association of College and University Business Officers, said she did not see a problem, so long as university officials paid to attend the events.

All of the university officials interviewed at the environmental conference saw it that way, too. 'It doesn’t bother me,' said Lisa Glover Henderson, director of energy initiatives at the University of Rochester. 'That’s part of the world we live in today. I don’t think there is a conflict.'

Although the Times article did not describe how many attendees were from health care organizations or had links to academic medicine, its web-site included a link to participant testimonials that included glowing words from an official of Boston University, whose Medical Campus includes the School of Medicine, and School of Public Health, and Presbyterian Healthcare Services, based in Alberquerque, NM. The senior vice president for hospital strategy and national facilities for the large not-for-profit managed care organization Kaiser-Permante delivered a talk, according to the organization's newsletter.

This story seems similar to that of the HRDI scandal (see post here). Once again, representatives of commercial firms that might want to do business with health care organizations (and universities and local governments) get enhanced access to officials who might be able to make purchasing decisions for a hefty fee. As Richard A Hesel said above, it appears to be "paying for access." There may be less polite words for it, but words more fraught with legal meanings.

As an aside, I can't figure out why the university, health care, and government officials would want to attend, given that attendance requires one-on-one sessions with prospective vendors, although maybe the setting was so luxurious that the $1000 registration fee seemed a bargain. But clearly there is reason to think that companies which paid for their representatives to meet academic and health care officials at this luxurious setting may have an inside track on selling goods and services to their organizations, regardless of the price or quality of those goods and services.

The impression created by this story is of academic and health care leaders who are part of a "power elite," attuned to luxuriating with their prospective vendors, but perhaps not to maximizing the resources needed for their missions of discovering and disseminating knowledge and caring for the sick.

Post Title → "Paying for Access" to Academic and Health Care Leaders at the Tamaya Sustainability Operations Summit

Kassirer on: Who Really Controls Medical Professional Organizations?

The journal Perspectives in Biology and Medicine's first issue of 2007 was about "medicine and industry." Since many of my colleagues are returning from the US American College of Physicians meeting and others are getting ready for the Society of General Internal Medicine meeting, I thought starting with the first topical article in the issue, by Jerome P Kassirer, entitled "Professional societies and industry support: what is the quid pro quo?" would be apt. [Perspectives Biol Med 2007; 50: 7-17.]

When I was researching my article based on physicians' thoughts about what was going wrong with health care [ Poses RM. A cautionary tale: the dysfunction of American health care. Eur J Int Med 2003: 14: 123-130 here] I found many cases of large health care organizations acting against physicians' core values, and of ill-informed, conflicted, and even corrupt leadership of such organizations. I was struck by how rarely physicians and other health care professionals caught up in these cases could find useful allies to defend their values, and particularly how rarely their medical associations and societies provided any useful support.

Dr Kassirer explained why this may be so. From his introduction,

Professional societies see themselves in noble perspectives. Their mission statements are nearly all the same: they tout their intentions to support research, improve care, advocate for patients, educate physicians, and foster communications. They implement these goals with numerous activities, including continuing medical education (CME) programs, clinical practice guidelines, informational brochures and Web sites, and grants to investigators. Some run gigantic annual meetings attended by tens of thousands of participants from all over the world. They give travel awards to promising investigators and achievement awards to leaders in their field who have distinguished themselves in science or practice. Undoubtedly they accomplish a great deal of good. Yet the growing support that nearly all of them solicit and receive, often millions of dollars each year, from the pharmaceutical, device, and biotechnology industries can threaten the very goals they espouse.

Kassirer went on to catalog cases in which medical societies' noble goals seemed compromised by conflicts of interest. They included:

• Society sponsorship of practice guidelines that supported the vested interests of the societies' commercial sponsors. Examples included: 1) an Endocrine Society guideline favoring aggressive testing for and treatment of androgen deficiency in older men, written by a panel with financial ties to the manufacturer of testosterone; and 2) the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition's guideline that recommended Propulsid for reflux in children after the drug's manufacturer donated almost half a million dollars to the society. (Another more recent example is the National Kidney Foundation's Amgen supported guidelines on the use of epoetin in anemia due to chronic renal failure, see post here.)
• Society sponsored educational materials that supported the vested interests of the societies' commercial sponsors. An example was a booklet on nocturnal gastroesophageal reflux produced by the American Gastroinestinal Association, underwritten by a drug company (Wyeth) that makes a proton pump inhibitor (PPI) drug, written by a panel all of whom had financial relationships with producers of PPIs, supposedly in response to a survey suggested and underwritten again by Wyeth.
• Society meetings "conflating informational material with commercial messages." Examples included intermixing scientific presentations and industry sponsored talks during meeting sessions, and allowing commercial logos on the society's newsletter.

Kassirer noted the various types of conflicts of interest that can affect medical societies. These included not only the sorts of conflicts implied above, but also:

• Society officers or board members who have financial relationships (e.g., consulting arrangements) with commercial firms
• Editors of society medical journals who have such relationships
• Society managers who know their financial position will be enhanced by industry funding of the society.

I should note that this list may not be exhaustive. There are a larger set of conflicts that can afflict societies' medical journals. Journals may have institutional conflicts of interest due to support from commercial sources in the form of "unrestricted" educational grants. Journals also get substantial revenue from pharmaceutical/ biotechnology/ device company advertising, (see relevant post here) commercial support for special supplements, and bulk purchases of reprints. Furthermore, associate editors, members of editorial boards, and reviewers can all have significant financial ties to commercial firms.

It is also possible that the full-time staff of medical societies have individual financial relationships which may cause conflicts of interest. I am unaware of any public discussion of this issue.

The broad implication, that various health care corporations, particularly pharmaceutical, biotechnology, and device manufacturers, may exert major influence over physicians professional societies and academic health care associations is very troubling. If physicians and other health care professionals do not control their own professional organizations, we have fallen into a sorry state.

WHAT IS TO BE DONE? - Kassirer closed with some concrete recommendations:

Restore professionalism to the organizations.

• Appoint as officers only those physicians who have no financial conflicts of interest.
• Restore a professional environment to medical meetings by gradually reducing the circus-like atmosphere of the exhibit halls, discontinuing the support of the industry-sponsored symposia, and insuring that scientific programs are not intermixed with industry-sponsored talks that can be mistaken for unbiased science.
• Rein in management's enthusiasm for financial support from industry.

Preserve and protect the integrity of medical information.

• Reject restricted grants for activities (guidelines, educational ventures) that have not been previously specified as one of the society's products. Accept unrestricted funds from industry only if they are unencumbered, in other words, requiring no payback.
• Require that all medical society journal editors who are in a decision-making mode in accepting or rejecting manuscript submissions have no financial conflicts.
• Protect clinical practice guideline committees from the bias of financial conflicts. As with society leaders and editors, the ideal is to choose those with no financial ties.

Make financial arrangements transparent.

• Do not provide demographic information of members and conference attendees unless these individuals grant their permission to do so.
• Insist on review of all new industry support for any possible quid pro quo by a committee of unconflicted society members.
• Reveal all sources of industry support on the society's Web site, including the amounts given. Identify also the specific purposes and projects for which the funds were employed.
  

I would urge physicians and other health care professionals who want their societies to represent their core values (and to be available to help members whose values are challenged by external threats) to push their societies' leaders to adapt Kassirer's recommendations at a minimum.

Of course, doing so may make for less lavish meetings, and somewhat higher dues. Wouldn't these costs be worth it to have professional societies that really uphold professional values?

Have we fallen so low that we cannot even control ostensibly our own professional organizations?

Post Title → Kassirer on: Who Really Controls Medical Professional Organizations?