Miriam E. Tucker

May 16, 2014

LAS VEGAS — Leaders of 5 major professional endocrinology societies have pledged to work more collaboratively together.

At the President's Plenary here at the American Association of Clinical Endocrinologists (AACE) 23rd Annual Scientific and Clinical Congress, the presidents of AACE, the American College of Endocrinology (ACE), and the American Thyroid Association (ATA), along with the immediate past president of the Endocrine Society (ES), and the president elect of the American Diabetes Association (ADA), shared the podium, each outlining the missions of their respective societies and identifying potential areas of collaboration with the others seated at the table.

"I think this was historic in the sense that it's the first time you've seen all the presidents together vetting issues. There has always been a very collegial relationship among the societies. Contrary to the perception that the societies don't work together, we do work together," AACE president Jeffrey I. Mechanick, MD, clinical professor of medicine at Mt. Sinai School of Medicine, New York, told Medscape Medical News in an interview.

Dr. Mechanick characterized the new initiative as "an attempt to now move the process forward, to reinvigorate the process of collaboration, [with] more cosponsorships of white papers, documents, and other activities, including but not limited to regulatory and legislative activities."

Current ACE president (and AACE past president) Daniel Einhorn, MD, medical director of Scripps Whittier Diabetes Institute, San Diego, California, noted that there is often dismay when the various societies come out with conflicting treatment guidelines for the same diseases. "Nothing makes us look weaker, nothing bugs people more than our appearing to disagree," he noted from the podium.

Dr. Einhorn said one of the best-known conflicts between AACE and the ADA, the difference in recommended HbA1c targets for people with diabetes, is "probably unnecessary." AACE advises that patients achieve a level below 6.5%. ADA's cutoff is 7.0%, but the latter has said more recently that lower targets are "reasonable" for some patients if they can be achieved safely.

"In retrospect, it was a gross oversimplification. The point was always to get the best possible target for the best possible outcome....No one would say one size fits all anymore," Dr. Einhorn told Medscape Medical News.

On the other hand, he said that one "very successful" collaboration occurred in July 2010, when the US Food and Drug Administration held hearings regarding the safety of rosiglitazone. In a joint statement, the ADA, AACE, and ES advised physicians about alternatives to rosiglitazone and cautioned patients not to stop taking any of their medications without first consulting their doctors.

That joint statement, he said, likely played a role in the FDA's subsequent decision to keep the drug on the market, albeit with very restricted use. "I think that was a wonderful example of how, when societies collaborate, we really can move the FDA and public opinion in the right direction."

Come Together Now

Dr. Mechanick asked each panelist to name public-health endocrine issues that could "be significantly improved within the next 3 to 5 years" by intersociety collaboration.

Hossein Gharib, MD, president of the ATA and professor of medicine at the Mayo Medical School in Rochester, Minnesota (and also a past AACE president), gave 2: negotiating for better reimbursement and promoting endocrinology training. "We want to sell ourselves as a profession that is gratifying in terms of both service and income," he noted.

Incoming ADA president Samuel Dagogo-Jack, MD, the A.C. Mullins Endowed Professor in Translational Research, professor of medicine, and chief of the division of endocrinology, diabetes, and metabolism at the University of Tennessee Health Science Center, Memphis, said, "I cannot find a larger problem than diabetes. The surge in diabetes, the pandemic expansion of the disease, and our ability to control it thus far represents the greatest challenge, but it's also the greatest opportunity."

Dr. Dagogo-Jack said that diabetes prevention and aggressive intervention for people with newly diagnosed type 2 diabetes were both areas of potential collaboration.

"Primary-prevention principles have been demonstrated repeatedly, in study after study for type 2....If society learns to leverage what we already have, by way of demonstrated efficacy of interventions to prevent type 2 diabetes and broaden the practice of diabetes 'preventology,' if you will, I think that's going to be a sea change," he said.

Endocrine Society immediate past president Dr. William Young, professor of medicine at the Mayo Clinic College of Medicine and Tyson Family Endocrinology Clinical Professor and chair, division of endocrinology, diabetes, metabolism, and nutrition, at the Mayo Clinic in Rochester, Minnesota, said that pushing for reversing cuts in federal research funding should be a priority for all the societies. His organization is advocating strongly, "but it isn't going to get fixed soon. We really need to rally around research....Everything I do today is based on advances in research, and it's under siege."

Specific research areas of potential for "rallying around" include the closed-loop system for insulin delivery, treatment for morbid obesity, and advances in diagnosis and treatment of endocrine malignancies, said Dr. Young,.

As for ACE — AACE's education and research wing — Dr. Einhorn said, "I worry about the dumbing-down of endocrinology practice, the overreliance of pathways and limitations on formularies, and the unnecessary barriers to being able to do the right thing for our patients. One thing we can do collaboratively is to make sure we know what the right treatments are, so it's not arbitrary, and the formulary director can't just decide not to do something."

He also expressed hope that the other societies would endorse the new AACE/ACE obesity initiative, launched at a consensus conference in March and continuing with a new "advanced framework" to be announced Friday at this meeting.

"For the first time we might do with obesity what we did for smoking, drunk driving, and some other things....I think we're going to lead the fight, and I hope you guys will be with us."

Dr. Mechanick told Medscape Medical News that the areas of potential collaboration identified by the panelists are not just a wish list, but that they will be acted upon. However, he also said that the goal isn't to harmonize everything. "I think there's a lot of advantage to diversity and having different voices....Having more than one society increases the robustness of the system, and it actually allows for more diverse ideas and a better shot at optimizing endocrine care."

Dr. Mechanick has received honoraria from Abbott Nutrition for lectures and program development. Dr. Einhorn has received consultant honoraria and/or research grant support from Amylin Pharmaceuticals, Bristol-Myers Squibb, Halozyme, Novo Nordisk, Mannkind, Sanofi, Takeda Pharmaceuticals, AstraZeneca, Eli Lilly, Janssen, and others. Dr. Dagogo-Jack has received research grant support and/or consultant honoraria from AstraZeneca, Ingelheim, Janssen, Merck, Santarus, and Novo Nordisk. Dr. Gharib and Dr. Young have reported no relevant financial relationships.

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