More Multaq: Prystowsky whack-a-mole, ACC responds, Sanofi overtures to EPs

In response to yesterday’s posting about several problems involving a supposedly independent ACC/HRS website (AFibProfessional.org) supported by Sanofi-Aventis, the manufacturer of Multaq (dronedarone), several new events have transpired:

Prystowsky Whack-a-Mole– The Eric Prystowsky lecture has been removed from AFibProfessional.org. An ACC spokesperson told CardioBrief that the ACC, in conjunction with its partner, HRS,  was “taking some immediate steps to address the issue that has been raised.” (By way of background, the off-label, off-guideline Prystowsky lecture was the only original content on the site, and there had been no disclosure that Prystowsky had received compensation for Sanofi.)

Update, Wednesday, March 31— An alert reader has pointed out that the Prystowsky lecture has now reappeared on the site, this time accompanied by conflict of interest disclosures.

The ACC spokesperson stated further: “Overall, we are planning to conduct an internal meeting to clarify ACC policies and procedures related to non-CME informational offerings.” In addition, “the editor-in-chief, Ken Ellenbogen… will be taking on more oversight responsibility.”

In a news report by Jim Edwards on bnet.com, Sanofi said it had “no control over the site’s content”:

This is independent of Sanofi … we sponsor a lot of professional associations and we are very transparent about funding for those organizations, and that’s the case here.

But the disappearance of the lecture doesn’t mean Prystowsky can no longer be heard on the subject of dronedarone. By sheer coincidence (I assume), earlier today I received an email “sponsor announcement” from theheart.org: “Watch Dr Prystowsky and Others Discuss Outcomes in AF Treatment. Join a panel of leading experts as they discuss atrial fibrillation and the role MULTAQ^®(dronedarone) can play in its treatment.” Other panelists include Gerald Naccarelli, Peter Kowey, and Barry Greenberg.

Comment– I don’t want to be too cavalier about this, but the whack-a-mole analogy somehow seems apt. I’m astonished by the sheer ubiquity of Prystowsky. (Yesterday’s post also discussed Prystowsky’s role in formulating the existing ACC/AHA/ESC AF guidelines and, as well, his role as “Medical Chair” of AF Stat Call to Action, a Sanofi-sponsored consumer site. Even if you’re inclined to believe that Prystowsky is the world’s #1 authoritative expert on AF, surely the medical community would benefit from a little more diversity of perspectives. (One point of clarification: although Prystowsky was a member of the 2001 and 2006 AF guidelines committees, he is not officially involved with the 2010 focused update.)

Sanofi Overtures to Electrophysiologists– In another bizarre coincidence, two private practice electrophysiologists, each well known in the blogosphere, reported receiving invitations from Sanofi to lecture or consult about dronedarone.

Westby Fisher, an electrophysiologist at NorthShore University HealthSystem in Evanston, IL reported on his blog that Sanofi had offered him $3000/day to serve as an advisor. He even posted a PDF of the letter of invitation. We are happy to report that Dr Wes (as he is universally known online) did not accept the invitation.

John Mandrola, an electrophysiologist in Louisville, KY, reported that a drug rep from a “huge pharmaceutical company promoting a new anti-arrhythmic drug” invited him to be on the company’s  speakers bureau and go to New York for speakers training:

“Well, I have my own slides on AF, and I’m an adequate speaker so you can save the cost of educating me,” I add with EP-like arrogance.
“Oh, …well, …its mandatory, and you have to use our slides.”
Needless to say, membership on their speakers bureau had far too many strings for me.

Mandrola’s conclusions are worth reading:

I take no income from any medical industry. Zero, not even pens anymore. This absence of financial ties feels great, like a puffer when you’re wheezing. Lack of conflicts provide an opportunity to speak freely, not even the sub-conscious is affected. As I grow older, more experienced and even a shade wiser, company logos in the margin of websites, or on the headers of emails seem so obvious.

Now, not all that is sponsored by medical device or drug companies is corrupt. Far from it. Leaders in industry, like JNJ, Medtronic, Boston Scientific, Pfizer and many others have enhanced our ability to doctor, and in doing so have enhanced the lives of patients. Good on them. But they are for profit entities with boards of directors, and shareholders who expect profits. Employing opinion leaders who nearly always reside in the cocoon of academics influence doctors who prescribe their products. I think this is called marketing.

Beware, you seekers of knowledge on the vast frontier of the internet.