March 16, 2010 -- A red dress has become the latest symbol in the ongoing debate about pharmaceutical company support of research or continuing medical education... but whose dress is it that is jauntily displayed on cans of Diet Coke?
The American Heart Association says it's "not our red dress," even as leading pharma critic Dr. Steven Nissen claims that it is.
Nissen, head of cardiovascular medicine at the Cleveland Clinic Foundation and a past president of the American College of Cardiology, debated the hot topic of industry influence with Dr. Robert Harrington, who is director of the Duke Cardiovascular Research Institute.
In his presentation, he said the red dress on the Coke can was a clear sign that the American Heart Association had crossed an ethical line by endorsing a soft drink, even as observational studies have suggested that soft drinks -- including diet drinks -- are major drivers of obesity.
Harrington, who was listed as the "pro" speaker in the debate, challenged Nissen about the soda can logo, saying that he did not believe the can had an AHA-approved logo on it. "I think that's NHLBI," Harrington said, referring to the National Heart, Lung and Blood Institute.
AHA president Dr. Clyde Yancy said Nissen had it all wrong. The red dress on the Diet Coke, indeed came from the closet of the NHLBI, he said. "And no money has changed hands between Coke and the American Heart Association," Yancy said.
Nissen made a fairly strong circumstantial case against the AHA. For example, after Circulation, the AHA's leading journal published research from Framingham investigators linking soft drink consumption to obesity, the AHA issued a statement that pointed out the limitations of the Framingham study.
The AHA also released a statement that raised questions about a proposal to tax soft drinks as a means of underwriting some healthcare costs while also, possibly, discouraging consumption of the beverages. The soft drink tax proposal came from a perspective published in the New England Journal of Medicine.
Nissen connected the dots from those actions and drew a line that pointed straight to a Diet Coke can.
A NHLBI spokesperson told MedPage Today that the dress in question is the logo for an NHLBI education program called "The Heart Truth."
And although Yancy said that Coke made a large donation to The Heart Truth, the NHLBI spokesperson said no money was involved in the branding deal.
"We have a partnership with Diet Coke," she said. NHLBI wanted and got "more exposure about heart disease in women" and that was the purpose of the partnership, she said.
Yancy told MedPage Today that the AHA often issues statements following publication of studies, especially observational studies. The goal of those statements, he said, was to inform the public of the quality of the findings. "It was disingenuous for Dr. Nissen to suggest otherwise," Yancy said.
But Nissen shrugged-off the AHA protestations. He said the AHA and NHLBI have an ongoing partnership to promote public education about heart disease in women.
An AHA spokesperson told, MedPage Today that the AHA-NHLBI agreement is limited to "co-branding of 'Go Red for Women' Day."
A close look at a Diet Coke can reveals a number of differences between the AHA dress and the NHLBI dress. The AHA version is a little more Texas -- swingy, strappy -- while the NHLBI frock is a bit more like a dress for a paper doll. "And their dress is not on a hanger, ours is," explained an AHA spokesperson.
But the NHLBI spokesperson said, "we had the dress first."
Both Harrington and Nissen agreed that there have been abuses in both research and CME funding over the years, but as expected they mapped out distinct camps.
Harrington devoted most of his time to discussing ways in which industry funding -- both research and CME funding -- should be subject to oversight. And he said that current rules governing industry funding of CME are "good rules, but the problem is often with us and the way we enforce those rules."
Nissen disagreed and he offered examples of single-sponsor CME that he said were "continuing marketing education, not continuing medical education."
He singled out a CardioSource CME program funded by Merck as an example and said it was one of many such examples.
The program, "Optimizing Patient Outcomes in Acute Heart Failure Syndromes: Strategies to Preserve Cardiorenal Function," Nissen said, was simply a marketing strategy to drive up interest in a drug, rolofylline, that Merck was developing for decompensating heart failure. Merck eventually dropped the development program as clinical trial results did not support a benefit.
"That drug is gone, but the CME program is still out there on CardioSource," Nissen said.
During the discussion period, Dick Pasternak, vice president of cardiovascular clinical research at Merck Research Laboratories, said it was unfair for Nissen to criticise a CME program without showing any slides from the program. Pasternak maintained that the program offered solid education about heart failure treatment.
Nissen said he had reviewed the entire program and he found it to be "marketing, not education."
Dr. Jack Lewin, executive vice president of the ACC, said that while he was sensitive to the issues Nissen raised, he believed that societies like the ACC could successfully manage relations with industry and that such collaborations were essential.