Collaboration between Industry and Physicians—An Essential Alliance

Over the past several years, influences outside of the practice and research medical environment have placed regulations on the relationship between industry and medicine that have significantly handcuffed medical advancements in the field. In a specialty as rapidly progressive and technology intensive as interventional radiology (IR), these restrictions are perhaps felt more acutely than most medical fields.

Few individuals will make the argument that things should return to the way they used to be. Everyone has heard stories of golf trips or lavish dinners paid for by industry representatives. Clearly, when such extravagances are given to the end user of a product, an inherent conflict of interest either occurs or the perception that it occurs cannot be far from the truth. Whether or not free pens with company logos or support for an educational dinner symposium exceed a reasonable threshold is a matter of opinion and open for debate. The details here are outweighed by the overarching theme—industry and medicine find themselves both in an environment where collaborative efforts must increase, but where policy and regulation makes it nearly impossible to do so. The authors of this editorial—one from industry and one from academic medicine—would like to jointly raise their concerns that now more than ever, partnerships between industry and medicine are crucial and in the long run healthy for the field and for patients.

From an academic standpoint, collaboration with industry provides several advantages. Funding, particularly for pilot studies or smaller clinical trials, are often provided by industry. It is true that there is the potential for conflicts of interest to occur in this setting; however, rather than throwing the baby out with the bathwater by refusing such funding streams out of hand, it is the responsibility of the investigator, industry collaborators, and especially academic institutions to manage such potential conflicts. One positive outcome of the crackdown on industry-supported research is that institutions now have many mechanisms in place to identify and control such conflicts of interest—anyone who works in an academic institution will confirm the presence of these mechanisms. Rather than looking at these as obstacles or hurdles to be overcome, the investigator (and industry collaborator) should instead understand that the purpose of these processes is to provide protection—protection to the investigator, protection to the private funding source, protection of the data, and eventually protection of the scientific process.

From a practicing interventionalist's perspective, collaboration with industry also provides significant benefits. It is nearly impossible for practicing physicians to keep abreast of all of the changes in their field—this is particularly true in the setting of declining reimbursements, since more time is being spent keeping the clinical enterprise solvent than keeping up with the latest advancements. Industry representatives are vital in this regard—whether presenting the latest and greatest tool or being present in the laboratory the first few times a new device is used, the bottom line is that industry presence directly leads to better patient care. Couple this with having a partner to bounce ideas off of or to act as facilitators to connect two practicing physicians, it is clear that industry presence is an incredibly important component to the practicing physician, not just to the academic IR.

From an industry perspective, collaboration is vital. The growing need for quality data and shrinking government funding for research makes the need for at least partial industry sponsorship critical to advance the practice of IR. The growing global regulatory requirements will also force needed industry dollars to fund studies. The oversight available should encourage, not discourage, the needed collaboration. A key component should be complete transparency on the purpose and funding of a study.

It is also difficult, if not impossible, to develop new devices without industry's interactions with clinicians. Industry does not independently conduct clinical trials and the profession does not independently commercialize products. IR became a viable part of medicine by solving clinical problems through collaboration with practicing physicians, engineers, and other experts within industry. A major part of IR's history is industry physician partnership. If we end those opportunities how will new and improved devices get to market? Clearly, technology transfer offices have had limited success getting clinician ideas developed on their own.

External influences, largely in the form of regulatory bodies, have placed so many restrictions and requirements on the medical field that forward progress seems to have been slowed appreciably. Although the purpose of these regulations is noble and understandable, the implementation of such decrees has proven to be overly restrictive and detrimental to advancements in the field of IR. Without a substantial and completely open relationship between industry, practitioners, and researchers in IR, growth of the field will be stifled and improvements in patient care will continue to be compromised. Ironically, as a result, those intended to be protected through the industry/medicine collaborative oversight are those who will eventually suffer—the patients we serve.