SRNT Newsletter

May/June 2004, Volume 10, Number 2

President's Column

by Ken Warner

I want to thank the members of SRNT for giving me the opportunity to serve as President. I take on the job with the appreciation (both meanings: understanding and gratitude) that an organization as strong as ours will move forward of its own momentum. The task of the leadership group is to sustain that momentum and perhaps nudge it slightly in one direction or another. In later columns, I will discuss the "nudges" I envision, and I now invite members to contact me with ideas of their own. This, my first column, will address the issues posed by the event that brought me to the presidency prematurely.

In a February 25 listserv message, members learned of Karl Fagerstrom's resignation as President-Elect. Although appropriate, as recognized by both Karl and the Board of Directors, Karl's resignation was most unfortunate for several reasons. First, it deprives the Society of the leadership of one of its most distinguished members. As well, it created personal discomfort for this most respected and even beloved colleague, a discomfort shared by all of us who care about Karl. The timing of the resignation also created consternation: Karl was to become SRNT's first President not from North America, and he was to preside over our first annual meeting outside the U.S., which will be held in Prague next March. Both the presidency of a distinguished non-American and selection of a European site for the annual meeting represented important steps forward in the growth and maturation of the Society.

Karl's resignation raises a series of challenging questions concerning members' connections with industry, the Society's rules and procedures for disclosing such ties, and determination of what constitutes a real or perceived conflict of interest. As Nancy Rigotti and I emphasized in the listserv message, Karl did nothing wrong. He violated no Society rules and his new relationships with Swedish Match raise no questions about his professional integrity, nor the nature or direction of his future work. Indeed, as he has explained, the new relationship allows him to pursue his dream of developing the next generation of nicotine replacement therapies, products that may make it possible for many more people to quit smoking and thereby avoid an early demise.

Other respected members of SRNT also have financial relationships with tobacco companies, often small, that make path-breaking research possible. As well, of course, a sizable fraction of the membership has, or has had, financial relationships with pharmaceutical companies. These companies' profit motive has produced scores of life-saving products, yet that motive is not always perfectly congruent with the search for research-generated truths. In an ideal world, independent scientists would have abundant independent resources, and financial connections with industry would be unnecessary. In our real world, however, those connections often make possible valuable research that otherwise would not see the light of day. The connections also foster support of scientific meetings, such as our own, that themselves enhance the scientific process and its contribution to society. Yet those connections do raise genuine questions about scientific dependence, potential and real conflicts of interest, and perceptions that themselves can be damaging. The connections are not costless.

What to do? Some members would prefer that we stop worrying about industry connections altogether; others want the connections themselves to cease to exist. In our complicated real world, neither group will ever be completely satisfied. Karl's resignation forces us to confront these issues directly, however. The Policy Committee, under the leadership of Brion Fox, is currently working on its previous charge to develop recommendations concerning industry funding of Society programs and events. Shortly, I will appoint an ad hoc committee to reexamine our policies on disclosure by members and officers and possible and actual conflicts of interest. Former President Harry Lando has graciously agreed to chair this committee, which will include members representing the full spectrum of views on the issues. The circumstances surrounding Karl's resignation illustrate the complexity of their task: What to take this example specifically should we do when a President-Elect is elected with one disclosed set of industry affiliations but would take office with another that might conceivably have affected his or her election? The work of these committees should move us toward a resolution that will be fair, sensible, and ethical, if not one that will answer all questions, nor necessarily please all members equally.

I want to close on an unequivocally positive note. I know that many members shared my reaction to the Scottsdale meeting. It was, plainly put, the single best scientific meeting I have ever attended. Thanks and commendations to the Program Committee, especially chair Laura Klein and co-chair David Drobes, and to SRNT Executive Director Beth Klipping and her colleagues, especially Sheila Kirschbaum. Finally, on behalf of the Society, I want to thank both Nancy Rigotti, our outgoing President, and Harry Lando, concluding his term as immediate Past-President, for their incredibly dedicated and visionary leadership. Thanks, too, to Karl for his service on the board as President-Elect and, more generally, for the extraordinary contributions he has made to public health.