Undue influence of infection control industry?
APIC responds to broadside from SHEA speaker
In the silence after the speakers had concluded the opening session recently in Orlando of the annual meeting of the Society for Healthcare Epidemiology of America (SHEA) — as those with questions were moving to the microphones — moderator Patrick J. Brennan, MD, acknowledged what many were thinking by noting that there was an "800-pound gorilla in the room."
He was referring to critical comments that had just been made from the podium about the Association for Professionals in Infection Control and Epidemiology (APIC). In question were remarks by Michael Edmond, MD, a health care epidemiologist at Virginia Commonwealth University Medical Center in Richmond, during a SHEA session on the quest to drive health care associated infections (HAIs) to zero.
"The effect of professional organizations has been mixed," he said. "I believe that SHEA has been too passive in allowing other stakeholders to dominate and define the agenda. And APIC, though more proactive, seems to use the current spotlight on HAIs more for self-promotion than as a catalyst for real improvement."
Specifically, Edmond criticized APIC's Strike Out Infection campaign with Boston Red Sox manager Terry Francona, who contracted a MRSA infection after surgery in 2002. Edmond noted that a link on the web site (www.strikeoutinfection.com) appears to promote use of antimicrobial dressings made by one of the campaign's corporate sponsors, Covidien Inc. A MRSA poster by the company urges athletes to cover all wounds — "even small ones" — with antimicrobial dressings. APIC's name is not on the poster. "Professional societies engaging in product promotion — whether explicitly or implicitly — place financial gains above all else, do a disservice to their members and the public, and in the end destroy their own credibility," he said. "I hope that SHEA never stoops to this."
Hospital Infection Control contacted APIC for a response to the charges. "I would really love to see Dr. Edmond become more familiar with all of the things that APIC has done to provide evidence-based practice resources, education for our members, and outreach to other organizations," answers Kathy Warye, CEO of APIC. "The "real improvement" APIC is involved in means better patient outcomes, reduced costs, and more appreciation for the role for infection prevention and control professionals, she says.
"In terms of self-promotion, I have difficulty separating promotion of a profession — which I think all of us agree is important — with the promotion of a professional society," Warye says. "It's really hard to separate the two, but if we are being accused of promoting ICPs — guilty as charged. This is a profession that has been underresourced and undervalued for a very long time."
Concerning the more insidious charge that APIC has fallen under the sway of the infection control product industry, Warye stressed that APIC has strict corporate sponsorship policies and uses the money to provide needed educational and professional benefits to its member ICPs. "What we are doing is consistent with what many health care organizations are doing, including others that are in our community," she tells HIC. "APIC has a policy for acceptance of corporate sponsorship that is consistent with all of the standards of practice that exist today. Our policy is very detailed and we actively enforce it. Look at the balance. What harm could we possibly be doing vs. the benefit that is being accrued?"
At SHEA, the comments opened up a broader discussion of industry and ethics. "It is really apparent that our health professions are enormously dependent on our support of industry to deliver our message and conflicts just naturally arise from those issues," said Brennan, chief of healthcare quality and patient safety for the University of Pennsylvania Health System in Philadelphia. "It is really something that every society, every professional has to examine."
A critic of the increasing emphasis on using active surveillance cultures to detect patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), Edmond cited a New York Times article that emphasized what a boon the practice has been for manufacturers of nasal swabs. The article's lead sentence, as Edmond read to SHEA attendees, is: "Patients might not particularly like the new admission procedure at a growing number of hospitals: having what looks like an elongated Q-Tip stuck up their noses. But it smells great to Cepheid [Inc.]"1
The role of industry in driving infection control is increasing, he warned. "Given industries vast resources, its ability to impact other stakeholders and the paucity of funding from federal government sources for infection control research, we must maintain a high level of vigilance for conflicts of interest to prevent the agenda from being diverted," Edmond said.
Kathryn Kirkland, MD, a health care epidemiologist at Dartmouth-Hitchcock Medical Center in Lebanon, NH, thanked Edmonds for raising issues that "are uncomfortable for us to deal with in public, particularly the issue of conflict of interest. We do put our disclosures up on our slides, but we don't talk explicitly about what the conflicts are and how they might affect how we think about an issue."
Any perception that infection control policy is being driven by industry is "a huge issue," added Victoria Fraser, MD, a health care epidemiologist at the Washington University School of Medicine in St. Louis. "The SHEA board spent a lot of time last year defining and writing out new conflict-of-interest policies," she said. "We have a continued commitment to trying to foster transparency in this area."
Reference
- Pollack A. "A Bug Rises, and With It a Company." The New York Times. March 4, 2008.
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