Over my 26 years of podiatric practice, I have had the pleasure of attending many fine podiatric medical and surgical seminars, both as a seminar registrant and a speaker. Having this many years of podiatry seminars under my belt, I have made some observations about how our seminars are conducted. These observations give me hope but also give me concern for the future of our profession.
On the positive side, over the past decade, seminars are including more research evidence in their lectures. This change has been welcomed by many who are striving to make podiatry into a medical and surgical specialty that is on par scientifically with any other medical specialty. Evidence-based research is shining more brightly at our seminar lectures, exposing many clinical beliefs to the light of more intense academic scrutiny and often demonstrating that these long-held beliefs are not fact but rather examples of persistent podiatric folklore. For this, I am extremely thankful that our seminar organizing committees are leading us in a positive direction.
On the negative side, at many of our seminars, there is an influence that is so interwoven into the fabric of the financial realities of a successful podiatric seminar that it may be difficult if not impossible to solve. This influence changes the content of the lecture and workshop presentations at our seminars. Likewise, it changes which non-surgical and surgical techniques will be promoted to the podiatric audience attending the seminar. Over time, this influence changes how podiatrists practice and will change the “standard of care” for many podiatric medical communities. The influence that I am so wary of within our podiatric seminars is that of financial conflict of interest.
In its least harmful form, conflict of interest is present but is relatively innocuous. There are many academic podiatrists who can remain completely objective during their lectures even though they have a financial conflict of interest with a company that does business in the subject on which they are lecturing. The reality of today’s medical world is that a podiatrist who does research, publishes papers and has a strong academic interest in a podiatric technology not only is a top choice to speak at a podiatric seminar on his or her academic specialty, but also is a top candidate to consult for a company that markets a podiatric technology within the academic specialty.
When I am listening to speakers who earn part of their paycheck from a company that markets a product they are lecturing on, my “skeptic antenna” is on full alert. I am constantly scanning the dialogue and content of the lectures to see if I am being provided with a true objective analysis of the pros and cons of each of the products and techniques available for evaluating and treating various pathologies.
Since I have worked as a consultant for a foot orthosis laboratory for the past quarter century, I am acutely aware of my own potential conflict of interest during my lectures. As a result, during my lectures, I specifically try to avoid mentioning even the name of the company for which I consult.
In the most harmful form of this “influence,” companies that make podiatric products or technologies may contact podiatry seminar organizing committees to offer lecturers at no expense to the seminar on the very same topic that directly affects the products they market and sell. Sometimes, these lectures may be the only presentations at the seminar on this specific topic. In effect, if the seminar organizing committees allow these product-biased lectures to occur instead of giving their seminar registrants a scientifically objective lecture, they may be giving their seminar registrants an “infomercial.”
One of the worst examples of this that I have ever experienced was when an orthosis lab owner, during a seminar on foot and foot orthosis biomechanics, showed 10 minutes of testimonial videos at the end of his lecture from two of our nation’s very prominent podiatrists touting the benefits of his lab’s products.
I believe we need to be a better medical profession than this type of nonsense indicates. Let us work together to make certain that our podiatric seminars contain the lectures that will present the best science and evidence available, and not contain the “infomercials” that, in the end, are costly to our profession’s continued academic growth.
Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is in private practice in Sacramento, Calif.
Dr. McCord retired in December 2008 from practice at the Centralia Medical Center in Centralia, Wash.