AWIS 40th Anniversary Meeting, Session Summary

UPDATE: TO BE PUBLISHED

The Frontiers in Sustainability Panel at the AWIS 40th anniversary conference consisted of three speakers, all from different areas of environmental science.

The first speaker, Ms. Kristen Graf, is the Executive Director of the Women of Wind Energy organization (WoWE). Ms. Graf started out as an engineering major intent on developing wind technology, but realized the technology itself is already developed. However, fossil fuels and nuclear energy still dominate the generation of electricity over renewable energy sources. The relative proportions of nonrenewables and renewables have actually remained fairly stagnant even with all of the media buzz and politicking surrounding renewables. This has happened despite wind power growing in popularity worldwide. Puzzlingly, this stagnation has occurred despite the increase in wind turbine production in the U.S. So why is this? These U.S. produced turbines are being installed in rapidly developing nations such as China and India. She addressed the need to keep some of the turbines here, both for the economic impact as well as the environmental impact. (She echoed Nancy Jackson’s remarks earlier in the day: if science jobs in the US are in peril, then improving opportunities for women in science in the US is bleak.) Ms. Graf’s interest in effecting this change in wind power usage led her to leave engineering and ultimately to WoWE. She stressed that there is only a small window of time left to act on issues related to global warming. Ms. Graf presented some real examples of success (Cornell and Denmark) in using renewables.

Dr. Helen White was the next speaker, and is an Assistant Professor of Chemistry at Haverford College. She presented the audience with an interesting environmental mystery that only a chemist could solve. Dr. White’s most recent research involved collecting samples from the Deepwater Horizon oil spill. While much of the media coverage of the event focused on surface tragedies, such as the plight of birds, the impact of the spill on the deep sea was rarely mentioned. In the deep sea near the spill, brown oil flocculates were observed. In the same area, biologists noticed deep sea coral with rare tissue damage: the polyps were literally falling off. The biologists attributed this damage directly to the spill. Dr. White was skeptical of the causation; there is a lot of oil found naturally in the Gulf of Mexico. In order to address this from a chemist’s perspective, she traced the source of the oil. After all, oil is not just one compound, it is a mixture. So oil from different sources will have different chemical signatures. After testing several samples using a novel technique called 2D gas chromatography, she determined the spill was not to blame for the coral damage. This result was unpopular with the biologists, but the evidence was striking. In doing this work, Dr. White found a new mystery to solve: she found some quite improbable chemical signatures in some of the oil samples. Her next quest is to uncover this mystery. She speculates that there may be undiscovered biodegradation pathways in the deep sea.

The last speaker was Dr. Cat Shrier, President and Founder of Watercat Consulting, LLC. Her company focuses on finding innovative approaches to sustainable water management. Dr. Shrier emphasized the need for the water industry to pay attention to the whole water cycle. While the main goal might be to deliver water to customers, issues such as water waste, integration with nature, energy cost of water, and energy production from water should be given higher priority. However, water utility companies tend to be very conservative and not supportive of public discussion. Dr. Shrier underscored the need to fight this, to create open spaces for education and public discussion. She mentioned her website for this, waterwonks.com, which will be unveiled soon. The conservatism and close-mindedness of the water industry naturally creates huge problems for women in this industry. While there are more women coming into the pipeline, there is a dearth of women in management positions. The industry is also self-regulated and there is no national association, making it difficult for these issues to even be raised. She stressed that these problems in the water industry are not history, they are happening now. Dr. Shrier believes the ultimate solution is to stop treating diversity as a nonessential, secondary issue. However, she admitted being unsure how to make this change happen.

All of the speakers touched on issues facing women in science that warrant a separate summary. Institutions, companies, and government all need diverse voices to make change and to be successful. We need more women leaders. As an example, we are woefully lagging behind other developed nations in the percentage of women holding an elected office. Women need mentors and to be mentors. Dr. White supervised an undergraduate woman for the research she presented. Ms. Graf mentioned a dark quote from Madeleine Albright, “There is a special place in hell for women who don’t help other women.” Further, we need men to be involved. Dr. Shrier noted that women cannot be solely responsible for their success or failure, as so much of career success has to do with standing on the shoulders of others. Lastly, all of the speakers testified to the importance of speaking one’s mind, whether it’s a call to action, an unpopular viewpoint, or bringing up a topic isn’t normally discussed.



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AWIS meeting report

Here is a report I did on the AWIS Philadelphia meeting. The topic was ethical considerations when pharmaceuticals and academic medicine mix. I am posting the full text here, or you can go to the AWIS-PHL website for a pdf version.

UPDATE: PUBLISHED IN AWIS MAGAZINE

October 2010 Meeting Report by Kerstin Nordstrom

Kathryn Ross (MBE, DMH (c)), the Research Coordinator for Quality Research at the American Board of Internal Medicine, gave a presentation entitled “Pharma’s Ties with Academic Medicine:“Ethical Concerns?” on October 19th at The College of New Jersey. This was a joint meeting between the Central New Jersey and Philadelphia AWIS chapters. She opened by formally defining a conflict of interest, a key issue for any ethical concern. A conflict of interest is a set of circumstances that create a risk that actions regarding a primary influence (e.g. patient health, research validity) will be unduly influenced by a secondary influence (e.g. financial gain) [1].

Conflicts of interest (COIs) are present in every stage of life as a physician: in medical school, in residency, in practice. Ms. Ross presented results of a survey of residency programs conducted by the ABIM. Program directors and senior residents were asked, “What constitutes a conflict of interest?” There were several striking differences between the two groups. For example, 61.8% of senior residents classified excessive moonlighting as a COI, contrasted with 79.4% of program directors. Other notable differences were: personal use of sample medication (73.4% vs. 82.5%), accepting pharmaceutical gifts/meals/entertainment (75.8% vs. 89.7%), and accepting unrestricted educational grants (62.1% vs. 17.5%). The survey further went on to ask, “What is allowed at your institution?” The notable differences of opinion were: pharmaceutical detailing of residents (14.9% vs. 33%), distribution of free educational material such as textbooks (34% vs. 56.7%), industry support of continuing medical education (13% vs. 47.4%), unrestricted educational grants (6.8% vs. 80.4%), and faculty serving as paid consultants (26.3% vs. 61.9%). Clearly, the survey results indicate a discrepancy that points to a lack of clear COI guidelines. The survey further found about half of the programs had COI guidelines for trainees, about half had COI curriculum, but only a small percentage (<10%) had any COI competency evaluation for trainees.

Additionally, there was a difference in the opinion on unrestricted educational grants (UEGs) between university settings (22.4% classified UEGs as COIs) and community settings (12.7%). This may reflect that university settings are more likely to be pharm-free. One might come to the conclusion that academic settings are then doing “better” with regards to COI than non-academic settings. Perhaps, but the overall results of the survey also show that neither setting is doing especially well in establishing clear guidelines. Also, academic settings are in a better position to effect change from the ground up by actually instituting formal COI curriculum.

Ms. Ross went on to emphasize that the stigma attached to the term “conflict of interest” must be thrown out. Conflicts of interest technically only refer to situations where there is risk of undue influence. Classifying a situation as a conflict of interest does not mean any transgressions have occurred. In other words, COIs do not necessarily need to be abolished (though specific kinds may be); there is simply a need for clear COI policies.

In fact, many conflicts of interest have positive aspects that ensure they are around to stay. An example is the industry financing of medical research. All three parties potentially benefit: industry may develop a new product, academia may discover an effective treatment, and ultimately the patient is the beneficiary. These benefits must be weighed and discussed openly against the main risk of the COI: the patient’s health may be influenced by the profit motive of industry. However, as long as this COI is disclosed and discussed openly, action can be taken to minimize risk.

Therefore, in order to effectively deal with COIs, the first step is disclosure. However, evidence suggests even this basic first step is not always undertaken. In another study [2] a sample of 41 paid medical device company consultants was taken. From this number, 31 had published an article on their research. Of the 31 papers, 25 were randomly selected. None of the 25 articles published COI disclosure. This points to a need for a standard practice for disclosure. A standard practice would not only increase the rate of disclosure, it would also reduce the burden for disclosing. An indirect benefit is that this would create a larger data set on which to base policies.

Once disclosure practices are in place, the next step needed to address a COI is to assess the likelihood and severity of harm. As medical COIs usually involve patient health, this step is critical. Finally, one can determine if a COI needs to be prohibited outright or may be managed.

The timing of the meeting was serendipitously on point. Just two hours earlier, NPR and ProPublica began broadcasting the results of their “Dollars for Docs” investigation [3]. Under the recent Health Care and Education Reconciliation Act was included a law called “Physicians Payment Sunshine Provisions” where all pharmaceutical companies must disclose all financial transactions with physicians starting in 2012. Some companies have started doing this already, and the investigation tracked the payments. The investigators looked at 384 of the highest paid consultants and found that many had no board certification and many had allegations or convictions of professional misconduct. Additionally, several of the companies had recently settled massive lawsuits regarding the promotion of off-label drug use. While these examples may simply be “bad apples”, clearly this does nothing to placate public notions that industry may be “buying” or influencing doctors in unsavory ways. With better COI procedures in place, doctors and industry may hope to win back the trust of the patient.

Interestingly, the nature of industry influence is evolving as well. Historically pharmaceutical companies have been able to get prescription data from pharmacies. They can then target their marketing to specific doctors with data mining. However, some states have recently restricted this practice. Anyone with a television has seen the result of these measures: an exponential increase in direct-to-consumer marketing because of this restricted access to physicians. The patients’ involvement in the marketing only compounds the complexity of COIs, underscoring the need to address them.

While some previous examples paint an unflattering picture of some companies, it is important not to demonize the entire pharmaceutical industry. Many companies have their own sets of ethics guidelines and may follow them well. Companies are also in business, so it is unfair to judge them for desiring to increase sales or to develop a new drug. Further, they are the experts on the drugs/devices, and so are the informational authorities. Certainly many COIs in academic medicine could be avoided if all research funding was pharm-free and all medical education funding was pharm-free. But neither option is realistic in our society. Therefore, it is important to establish clear guidelines regarding COIs and to begin to establish formal COI training.

Ms. Ross ended the presentation by summarizing a recent meeting report from the Institute of Medicine [1]. The report summarizes recommendations to help medicine address COIs. Recommendations for academic medical centers (AMCs) are organized into three main points: 1) At AMCs, Prohibit gifts, ghostwriting, speakers bureaus, and limit drug samples, consulting, sales representatives. 2) Provide education on relationships with industry and COIs. 3) Develop a new system of funding accredited continuing medical education that is free of industry. Hopefully, AMCs can adopt these policies and standardized practices will result in the future.

While some might dismiss professional ethics as a personal rather than professional skill, the bottom line is over 90% of physicians get some form of industry support, and practically all medical research is industry-funded. While this is not necessarily a bad thing, many of these relationships necessarily entail conflicts of interest. It is of utmost importance to ensure these COIs are well-managed and prohibited when necessary. By managing them effectively, patients may be assured that their doctors have their best interest in mind: their health.

The presentation was followed by a fruitful discussion with the audience as well as a tour of our host institution’s science facilities.

[1] Conflict of Interest in Medical Research, Education and Practice, IOM, April 21, 2009
[2] Chimonas, Susan, Frosch, Zachary, Rothman, David J. “From Disclosure to Transparency: The Use of Company Payment Data” J Arch Intern Med (2010)
[3] http://www.propublica.org/topic/dollars-for-doctors/