GAME: Opening keynote

While I have a few minutes during the morning break, I'll try to catch up just a bit.

Thomas Stossel, MD, with Harvard Medical School, was a very intriguing and thought-provoking, not to mention passionate, opening keynoter on Sunday night. He talked about a lot of the same things he has in published articles and his testimony before the Senate Subcommittee on Aging last summer, but I didn't expect him to be as funny as he was.

Anyway, the main theme of his talk can be summed up with this quote: "Industry contributions are now dominant and alleged to be tainted. Truth is that it is tainted--taint enough." (Yeah, it took us all a second to get it, too.) He cited all the medical advances that have come about since he first became a doctor, and how industry collaboration with practitioners resulted in those life-saving innovations. He then contrasted that list with the shorter list of violations that have occurred, and pointed out that, while pharma and device companies usually settle to avoid debarment from doing business with the government, many of the individuals involved in the violations fought back and won their cases. He also posits that the allegations were not evidence-based.

He contends that COI is meaningless, because interests are never perfectly aligned (except in anthills), and that conflict allegations have led to what he called the "toxic policies" of the ACCME, IOM, etc. (He was particularly harsh about ACCME.)

These policies, he said, are toxic because:

1. They entail a massive confession of all connections with industry.

2. They inhibit freedom of speech.

3. They inhibit the freedom to be rewarded based on excellence.

He said the cost of these policies includes impaired risk-taking and reduced investment in innovation, less, and less diversified, training and education; empowerment of second-hand expertise for education; and wasteful diversion of time and resources to disclosure and compliance.

The upshot, he said, was the idea that "doctors should be educated in a monastery wearing a hair shirt that they paid for themselves, instead of how all other professions are educated."

Some favorite quotes:

"Remember that the death rate is one per person."

"Research is not innovation. Innovation requires research and implementation."

"It isn't money that's bad for medicine, it's the lack of money."

This is just a little piece of what he had to say, but the next session is starting. Anyway, agree or disagree (I found myself doing both), his was a fascinating diatribe, and an energetic way to open the meeting.

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