Prystowsky lecture resurfaces, this time with COI disclosures

It’s back. This time with a disclosure of conflicts of interest. The Eric Prystowsky lecture that was the only piece of original content on AFibProfessional.org, the Sanofi-sponsored website run under the auspices of the ACC and HRS, is back on the site once again after being removed last week after a critical story was published here on CardioBrief. (Click here and here to read the full stories from last week).

Here’s what Prystowsky disclosed:

As of March 1, 2010, Prystowsky had “significant” relationships (ie, at least $10,000 was involved, no time period specified) with Boehringer Ingelheim, Medtronic (listed twice), Boston Scientific, St Jude, Sanofi-aventis, CardioNet, and Stereotaxis (listed twice). For all of these companies Prystowsky described his relationship as falling in the category of “Consultant Fees/Honoraria.” For Stereotaxis and CardioNet Prystowsky also disclosed he received at least $10,000 for work under the category of “Officer, Director, Trustee, or other Fiduciary Role.”

So: case over, puzzle solved. Right? Well…

I’m glad that someone fixed the obvious and glaring omission of the COI disclosures. I’m pretty sure that all future contributions to the site will contain similar disclosures. BUT, I don’t think the puzzle has yet been solved, or that we’ve even found all the different pieces.

Disclosures need to be much more detailed. There’s a big difference between $10,000 and $100,000. And the characterization of the relationship needs to be much more precisely defined. “Consultant Fees/Honoraria” can mean almost anything. If we are to be able to fairly evaluate the conflicts of Prystowsky– or anyone else– we will need more precise and detailed disclosure. Or perhaps the real purpose of these forms isn’t to actually provide meaningful disclosure, but rather the illusion of disclosure, transparency and accountability. Hmmm.

Transparency goes way beyond disclosure. Simply putting up a disclosure statement doesn’t eliminate the remaining problems concerning the Prystowsky lecture. Still unaddressed: why is it appropriate for  an ACC/HRS site sponsored by Sanofi to produce as its first piece of orignal content a lecture that promotes the off-label and off-guideline use of a Sanofi drug by a key opinion leader who also receives significant compensation from Sanofi? (Further, as we wrote earlier, Prystowsky’s lecture relies heavily on subgroup analysis, nonrandomized comparisons, and secondary endpoints.)

Accountability goes beyond COI disclosures. AFibProfessional.org, still contains no genuine information about who runs the site. Although Kenneth Ellenbogen is listed prominently as the editor, there is no listing of editorial staff or anyone else responsible for the content or management of the site. As I wrote earlier, in general, real publications and websites that produce valuable content go to great lengths to give credit to the people who produce the content. The people who produce these products are proud of their work and are pleased to claim credit for what they do. In sharp contrast, ads and PR campaigns are almost always anonymous.

“Benign neglect” or “contemptuous indifference”? A friend asked me recently if I thought the problem with AFibProfessional.org “was a question of trying to test the waters to see how far this type of presentation could go or was it a question of no one paying attention?” I responded that I didn’t know any of the details about or personalities involved in the creation or management of the site. I would hazard a guess that content inevitably is neglected when non-content people are involved and in control, because they basically have absolutely no respect or interest in the content itself. So it’s not so much “benign neglect” as “contemptuous indifference.” But I really have no idea. Perhaps at some point I’ll return to this idea.

…why is it appropriate for  an ACC/HRS site sponsored by Sanofi to produce as its first piece of orignal content a lecture that promotes the off-label and off-guideline use of a Sanofi drug by a key opinion leader who also receives significant compensation from Sanofi?