At a crucial early stage of their careers young interventional cardiologists attend brief training courses that are considered essential for their careers. It is not generally appreciated that large device and drug companies provide the money that enable these young doctors to attend these meetings. The money from industry covers the cost of travel, hotel, meals, and tuition.
For these doctors in training, who are at the very beginning of their careers and who do not earn a lot of money, the financial support from industry is highly welcome. Not incidentally, these courses also serve as an ideal setting for the device companies to establish a close relationship with these young doctors who are on the verge of becoming high value customers who will be directly responsible for the purchase of millions of dollars of medical devices like cardiac stents.
Industry does not give the money directly to the young doctors. Instead, the money goes from companies to nonprofit medical organizations who organize the courses. One such organization is the Cardiovascular Research Foundation (CRF), by far the most influential medical organization for interventional cardiologists, who implant stents, heart valves and other devices in people with heart disease. Among the CRF’s many programs and activities, the annual Transcatheter Therapeutics (TCT) meeting is by far the most important interventional cardiology meeting of the year, attended by thousands of interventional cardiologists and other physicians. The TCT meeting is particularly well known as a forum for demonstrating new cardiac devices and for giving industry a myriad of opportunities to interact with these doctors.
Less known, and far smaller and intimate, is the Interventional Cardiology Fellows Course, which is being held this year in April in Orlando, Florida. The course, as described by the CRF on its website, is designed to expose “the advanced interventional cardiology trainee to all facets of coronary, structural, and endovascular intervention. The faculty features renowned pioneers and innovators in the field, as well as rising stars in interventional cardiology.” About 300 doctors, most of them interventional cardiology fellows, attend the three-day meeting. (Similar courses for training fellows exist in cardiac electrophysiology and in other device-heavy medical specialties such as orthopedics.)
The website for the Fellows Course also makes clear that the meeting gives industry the ideal setting to “invest and build connections with fellows— tomorrow’s leaders and decision-makers.” But the role of industry in this meeting has not been the subject of significant public discussion or thoughtful scrutiny. Nor are the details of industry involvement in the meeting generally known.
Companies spend a lot of money for their presence at the Fellows Course, starting with $12,000 for a 10′ x 10′ booth and $23,000 for a 10′ by 20′ booth. CRF also offers companies a wide variety of additional sponsorship opportunities, including:
$5,000 for the interstitial screen which is displayed when the meeting app is started.
$1,500 for banner ads on the app.
$1,000 for push notifications on the app.
$8,500 to sponsor wireless internet and to place the “company or product logo on the wireless internet home page with a link to your company website.”
$3,500 for customized hotel key cards.
$3,500 for customized hotel key card sleeves.
$3,500 for hotel room door drops.
$6,500 for lanyards. “All attendees will have one around their neck with a badge on. Your logo will go on the lanyards along with the CRF logo.”
Perhaps most important, the device companies can also spend between $13,000 and $20,000 for the right to put on their own educational sessions, known as satellite programs, during meal times.
I asked the CRF to provide its rationale for the meeting, which does not offer CME (continuing medical education) credits because of rules prohibiting CME providers from allowing industry to underwrite meeting attendance):
“The Fellows Course, now in its 24th year, covers a broad array of topics in interventional cardiology in a data-driven fashion, including indications for procedures (i.e. when to do and when not to do them), procedural technique, complication management, career advice (both academic and practice), and more. In this regard, there is a clear need for comprehensive Fellows education independent of direct industry-organized and run programs. In order to allow Fellows to attend without assuming the burden of costs for travel and hotel, the course is supported by multiple industry sponsors through independent grants. The sponsors have no input or role in the selection of the attendees or faculty, or development of the main program, which is written and organized by the Course Directors to the same standards as other CRF CME-accredited programs. Unfortunately, despite conducting the course to these independent standards, CRF cannot offer CME for this course as ACCME rules prohibit providing registration and travel expenses for attendees of a CME-accredited program.”
I also asked a wide variety of interventional and general cardiologists for their thoughts about the meeting. There was broad agreement that the Fellows Course is highly valued by the fellows and their training programs, and that it would be a significant economic burden on fellows if they had to pay for their own attendance.
“Yes the CRF fellows course is an excellent one, one in which I have taught in years past,” one well known interventional cardiologist told me. “It is among the best sources of education for Interventional fellows. I do remember having attended the CRF meeting as a fellow and it was highly recommended that I attend at least one from prior trainees. My suspicion is that most fellows try to get to some equivalent during their training.”
Vinay Prasad (University of Oregon) is an oncologist who has written extensively about conflict of interest in medicine. “It is not easy to be a fellow in cardiology or any of the other medical subspecialties,” he said. “Fellows work real hard, long hours for pay below what is fair or reasonable, and fellows have few opportunities for paid trips. When fellows get the opportunity to attend a funded conference or retreat, as an attending you can’t help but feel: they deserve it! I know I feel that for my fellows.”
But, Prasad points out, “so many of these activities are marinated in industry funding. They are soaked in industry influence. They are teeming with industry reps and liaisons. These conferences often repeat the same half truths you hear bandied about by the thought leaders, i.e. those academic physicians willing to have their thoughts led by their industry colleagues.”
Prasad asked whether the course “seeks to include a balanced set of ideas of presenters” or, instead, “seeks to defend the value of the status quo, which is a lot of stents placed that brings in a lot of revenue and may or may not benefit patients. Some of the speakers are prominent interventionalists who have received multiple millions of dollars in annual compensation, and we know this through public 990 forms.”
Prasad said this is a general problem in medical education. “I don’t have the resources to run a course without industry influence called: reading trials critically. I wish I could fly fellows to Portland for 4 nights in the Skamania Lodge, where I and a team of non-conflicted academics teach them to read papers, see past the industry influence in promotional materials, ask good questions, etc. But I don’t. And that’s the way money works in medicine. Money is the power to gain access to physicians and choose what they hear.”