COMMENTARY

Will New Rules on Industry-Sponsored Travel Turn European Meetings More American?

John Mandrola, MD

Disclosures

June 12, 2016

The decision in 2015 by MedTech Europe, a group of industry associations, to adopt a new code of conduct of ethical business practice may change the face of European cardiology meetings.

In the brightly lit and bustling industry expo hall at the European Heart Rhythm Association (EHRA) EUROPACE-CARDIOSTIM 2016 meeting, I had a conversation with Prof Helmut Puererfellner (Elisabethinen Hospital, Linz, Austria) about the new regulations governing industry sponsorship of delegates.

Puererfellner is a senior member of the EHRA and vice chairperson of the scientific program of next year's EHRA meeting in Vienna. He's concerned about the future of scientific meetings in Europe.

Why?

The new regulations curb the current situation, in which many, especially younger, attendees receive direct industry sponsorship to attend meetings. Sponsorship can include the cost of travel and the conference fee. Given the locale of these meetings in tourist cities, these monies are significant. Few younger European cardiologists can afford conference fees of over €1000, let alone travel to places like Nice, London, Rome, or Vienna. Puererfellner told me this, and colleagues from multiple countries confirmed it.

Another striking fact I learned was that abstract presenters still pay conference fees. That is crazy. These are scientific sessions, after all. Those who produce the science ought to be rewarded. Instead, it is senior "invited" faculty who enjoy free passes.

The European sponsorship arrangement of attendees is entirely different from that of the US. As an American physician, I am well accustomed to strict regulations regarding industry sponsorship—of anything. I can remember going to meetings in the 1990s with support from industry, but this practice has long since stopped.

A tightly knit doctor-industry alliance, therefore, could be one of the reasons that procedures such as renal denervation and left atrial appendage closure were adopted and performed in Europe many years ahead of the supporting evidence.

In our conversation, Puererfellner said it was important to see both sides of the problem. On the one hand, he agreed that industry sponsorship has effects in terms of conflict of interest. But he also critiqued those who simply decree the sponsorship as bad and stopping it as good.

"You can't just say stop the practice and then offer no solutions. Without solutions to the cost problem of meetings, attendance will plummet, and this will have a chilling effect on medical education," he said.

I agree. In-person meetings are important, especially in device-heavy fields like cardiology.

It would be sad and possibly detrimental to patient care, if European meetings went the way of American meetings, where attendance has diminished. It's not uncommon to attend sessions at AHA and ACC in which large conference rooms are nearly empty. In the halls of American meetings, three groups stand out—young trainees who have posters, industry reps, and senior professors. You see far fewer regular practicing docs than in years past.

At this year's CardioStim meeting, for instance, I heard speakers from various European countries discuss widely different techniques to treat arrhythmia. I spoke with colleagues from four continents. I learned new things from these conversations. Maybe others learned from my words.

You can't quantify the benefit of these interactions, but they are surely good for patient care. And, make no mistake: these sorts of conversations don't happen during webinars or in email exchanges. Yes, social media is a terrific new tool, but it does not replace in-person interaction.

That said, untangling the knots of industry and medical education is also a positive goal. It's the height of naiveté to deny industry sponsorship of travel does not help industry. That's the good thing about industry: there is no hidden stitch. Their goal is clear: it is to sell more product. That's not sinister. It's the way the system works.

Puererfellner told me these new rules do not mean industry will stop sponsorship. Money will still flow to professional societies and other forms of CME.

Another truth is that European physicians will likely remain less well compensated than their American peers, so the cost issue of meetings will persist.

I'm no wizard, but it seems there are possible solutions to this new reality.

One change Puererfellner and I discussed is shortening the sessions from 4 to 3 days. Invariably, the fourth day of the meeting is sparsely attended and usually offers little new science. Plus, even the most earnest attendee is saturated after 3 days.

Another change would be to reward the scientists. I've submitted abstracts; it's hard work. It deserves an incentive. Of course I know meetings need marquee speakers, but there must be more sharing of the wealth with the science producers.

Another solution would be to take some of the money from industry to defray the cost of hotels and conference fees. The reality is that $1000 or €1000 is simply too much—even for better-compensated US physicians.

If you have other solutions, feel free to leave them in a comment. Meetings are important. So is a clear, less-biased view of the medical evidence.

We need both.

JMM

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