What Is the Parsemus Foundation?

July 15, 2011

July 15, 2011 (Stanford, California) — When Elaine Lissner learned that a physician had recommended her father undergo an angiogram, she began doing some research on her own, eventually coming across the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. Worried that her father might receive an unnecessary procedure as a result of the angiogram, Lissner opted to seek out a second opinion.

Based in California, Lissner sought out Dr Rita Redberg (University of California, San Francisco), also the editor of the Archives of Internal Medicine, because of Redberg's clinical and research interests. Lissner said her family went to Redberg because of her work showing that physicians were continuing to treat patients invasively in some instances, even though the data did not show any improvement in clinical outcomes.

Based on the consultation with Redberg, her father was treated with medical therapy and underwent an extensive rehabilitation of his lifestyle habits, including losing 15 lbs, said Lissner.

The experience, says Lissner, prompted a one-time, unrestricted gift from Lissner's not-for-profit Parsemus Foundation to the Archives' "Less-is-more" series [1]. Launched in April 2010, the series focuses on medical cases in which "less healthcare results in better health." According to the editors, the feature has proven to be very popular with physicians, so much so that they continue to receive more and more case reports and journal articles as the series progresses.

It's also a good fit with Parsemus, says Lissner. The overarching goal of the foundation is to find "low-cost solutions neglected by the pharmaceutical industry." The primary focuses of the foundation are contraceptive development and breast cancer, but there is also an interest in ending inappropriate angioplasty use and the promotion of evidence-based medicine.

"Basically, the idea with the foundation is that we're a nonprofit foundation doing medical research," said Lissner. "It's about doing things the most sensible way, even when the most sensible way isn't the most profitable. There is no pharmaceutical involvement at all, so there's no profit motive."

A One-Time, $50 000 Gift

Parsemus is a small family-based foundation, with the money derived from investments in a construction and real-estate business. The foundation has been in existence for approximately seven years and donated approximately $50 000 to the Archives of Internal Medicine in 2010, all with the intention of being put toward the "Less-is-more" series.

The series includes cardiovascular articles that have examined the impact of coronary computed-tomography (CT) angiography on patient and physician behavior in low-risk patients, the consequences of overuse of invasive coronary angiography, and most recently, an analysis of the National Cardiovascular Data Registry (NCDR) showing that clinicians were still performing late PCI in some patients, despite the guidelines showing there was no clinical benefit to be gained.

"It's scary to think there are people exposed to risk without any known benefit," said Lissner.

Speaking with heartwire , Redberg said the series was launched because there is a belief in medicine that one more test won't hurt, even though there are some treatments, including diagnostic angiograms and CT scans, that pose a degree of inherent risk. In addition, the series included a popular "Top 5" list of activities in family medicine, internal medicine, and pediatrics that would improve the quality of care. The section editor of the series is Dr Deborah Grady (University of California, San Francisco).

A selection of other cardiology and general medical journals polled by heartwire said that they have not previously partnered with nonprofit groups for core journal content, or that it was not "common practice" at the journal, although some said they accept sponsorship of journal supplements, with a minimum of two different sponsors.

Playing Devil's Advocate

Not everybody, however, believes that Archives has been up-front about the series' funding. Speaking with heartwire , Dr Ajay Kirtane (Columbia University, New York), a practicing interventional cardiologist, took issue with the "intermittent" disclosure of funding. He added that if a journal series were funded by a stent manufacturer, that information would be displayed prominently and the series would be read with skepticism.

A search of the 108 published original articles, editorials, and correspondence shows that just one editorial discloses that the "Less-is-more" series is supported in part by a gift from the Parsemus Foundation.

"If you want to look at this in a devil's-advocate sort of way, you could say that you have a foundation giving money to the journal to advocate against angioplasty," said Kirtane. "I personally do think that there are inappropriate procedures being done out there, and that's a problem that needs to be addressed. But I also think that as a result of a one-sided series of articles that receives widespread media attention, there might be inappropriately medically managed patients as well. We see that, we see patients who have been told that PCI doesn't help at all."

Kirtane told heartwire that he had a patient in the midst of an acute ST-elevation MI who had heard on the news that PCI was no better than medical therapy. The patient told Kirtane that he did not want to have an intervention. Luckily, the patient was convinced that he did not meet the criteria for COURAGE and that he needed to be treated invasively. Kirtane also noted that the wording about the angioplasty initiative on the Parsemus Foundation website changed in the last year: while they now support ending "inappropriate angioplasty use," the former title of this effort was known as the "antiangioplasty project."

Redberg told heartwire that the financial information about the Parsemus gift is not disclosed because the original articles and accompanying editorials were not funded by the foundation. The $50 000 gift was used for editorial purposes, she said, such as hiring a research fellow and science writer. The Parsemus Foundation was not involved in the establishment of the "Less-is-more" series, nor does it play a role in the selection of journal articles, she added. Redberg said the articles are selected based on their clinical implications, specifically chosen to highlight areas of internal medicine where less utilization of healthcare results in better health outcomes. She called the Parsemus foundation’s choice of the former title "antiangioplasty project" inappropriate but noted that it was later amended, something she was not involved in.

That said, Kirtane remains irritated that Archives would take money from an organization that clearly has an agenda against interventional medicine and said that the journal, in accepting the money, is complicit in agenda-driven healthcare. He notes that the Parsemus Foundation produced and displays on its website an "ironic graphic" that asks patients, "Why feel helpless about your coronary disease?" The poster sardonically recommends they try angioplasty, the "21st century's answer to leeches."

"To someone who does interventional cardiology, and I know for a fact that there are many people I've helped, that poster is offensive," said Kirtane.

Lissner, for her part, speaks openly about her motives and says her goals are simple.

"After the experience with my father, I wanted to know about how we could get this information out. Medicare is spending a lot of money on these procedures, some of which patients might not need. Rita told me about the series and that they were looking for funding."

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