Thursday, July 16, 2009

Cardiologists on COI: Tripping Over Your Own Illogical Arguments

Our colleague Roy Poses has just posted on his Health Care Renewal blog--

--a handy summary of a recent editorial in the Journal of the American College of Cardiology by the College's president, Dr. Alfred A. Bove. Dr. Bove was taking exception to the previous editorial by Rothman et al. in JAMA calling for more arms-length relationships between industry and professional medical organizations such as the College of Cardiology.

Dr. Poses gives us a two-part analysis of Dr. Bove's diatribe. First, he dissects the editorial itself as a professor would a student's paper in a basic course in informal logic. He counts up the logical fallacies committed in the editorial and notes that the entire argument rests on these fallacies without a single sound premise among them. Next, Dr. Poses lists the sums of money that the ACC receives from industry sources--amounting to about 38% of its total revenues, which, as I show in HOOKED, is not out of line with other major professional societies, to the extent that we can even find out as their finances are generally shrounded in secrecy. Among other tidbits, Dr. Poses reveals that unlike common practice at most professional societies, ACC enjoys today sufficient revenues to allow it actually to pay salaries to its elected officers. If the salaries this year are the same as in 2007, Dr. Bove is being paid about $147,000 for his service for one year as president of ACC, a sum that might not be paid if ACC were to forgo its cushy relationships with industry and the stream of industry cash flowing into its coffers.

Dr. Poses does not mention, but I did in a previous post ( that the ACC was one of the first and biggest medical organizations to join PIPC, or Partnership for Improving Patient Care, a largely-drug-industry-funded stealth campaign to gut comparative effectiveness research. The organizations that are members of PIPC show thereby that they are much more anxious to do the bidding of industry than to further the goals of scientific medicine or the true interests of patients.

So let me come at this in a slightly different way from Dr. Poses. Dr. Bove apparently thought that by writing this editorial, he was undermining the case of Rothman et al, and effectively convincing the world that it's a good thing for medical societies to be open to taking industry money to pursue their ends. What he has managed to demonstrate is quite the opposite. First, he has shown that he has not a single logical argument to offer to rebut Rothman et al. Second, he has shown that everything he knows how to say, in defense of his own position, really boils down to "trust me"-- and as I was pleased to quote from P.G. Wodehouse in HOOKED, "When an Englishman says 'trust me' it's time to start counting the spoons." Finally, if we look at the big picture of what the ACC has been involved in recently (and for some years previously as I note in my earlier post), we see the opposite of what Dr. Bove claims--clear and serious danger signals about what happens to a medical organization when it decides to climb aboard the industry gravy train. It seems clear that if the organization goes down that pathway, it readily confuses its own (and its patients') interests with the behest of the industry; and its officers' brains turn to mush as they struggle to rationalize all this and pretend that it's all on the up and up.

Rothman DJ, McDonald WJ, Berkowitz CD et al. Professional medical associations and their relationships with industry. JAMA 2009; 301: 1367-1372.

Bove AA. President's page: relations with industry: thoughts on claims of a broken system. J Am Coll Cardiol 2009; 54: 177-179.

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