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I spent this week in a conference centre the size of an airport for the Annual American Heart Association conference in Orlando, Florida. With over 25 000 delegates, it represents the world’s premier meeting for doctors and researchers interested in vascular disease. For 5 days, there were presentations, posters and seminars about every conceivable aspect of diseases that block up your arteries. There is far too much to mention individually, but some of the highlights for me were (1) research showing that coronary heart disease (CHD) and its underlying cause, atherosclerosis, are lifelong processes that start in childhood and might be programmed by the intrauterine environment; (2) evidence that multivitamins, particularly vitamin A, C and E do nothing to protect us from CHD; and (3) a trial of transcendental meditation showing its protective effect on CHD.

However, the most fascinating session I attended was about the so-called “Sunshine Act”, which is currently going through the United States legislature to completely overhaul the interactions between physicians and the pharmaceutical industry. In the 15 years that I have been visiting the US, I was always struck by the scale of the pharma industry and its lobbying power. However, in the massive exhibition hall at a conference that used to be brimming with drug companies and freebies, the restrictions were clearly visible. No free pens, no free food, and nowhere near as much hard-sell. The new bill will make it mandatory for any interactions, particularly financial, to be reported, leading to more openness from health professionals and industry, whether in relation to education, research or corporate hospitality. At the conference, both journal editors and scientists discussed what should represent “disclosures”and “conflicts of interest”. If this bill becomes law, America will be leading by example in an effort to rebuild trust in medical practice and to preserve the independence of clinicians.

The attendees of the session found out that the speakers were not the first-choice speakers for this debate. The conference organisers had asked the two US Senators who were in charge of the Sunshine Act and government advisors from Harvard to lead the session, but they had all declined because they would not be receiving an honarium from the American Heart Association. It is interesting that policymakers and other public servants expect doctors to be impartial and independent in their practise and yet they are happy to accept speaker fees and all manner of expenses in the name of their jobs. This is not an American problem as our hugely embarrassing MPs’ expenses scandal in the UK illustrates. We cannot have one rule for one sector, and one rule for another. Wherever taxpayers’ money is at stake and people are employed in a public service, there should be certain standards across the board.

As the US Senate prepares to vote on President Obama’s proposed health reform bill, which would greatly broaden access to healthcare, the previous Chief Executive of the NHS, Lord Crisp, suggested that the NHS and the Department of Health in the UK need to separate in order for greater accountability to the taxpayer, and greater independence of the NHS. There is clearly no one solution to better healthcare and better accountability, but any move that leads to greater transparency will surely be a good thing.

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