Polio crippled President Franklin D. Roosevelt, and it infected and often paralyzed thousands of other Americans—58,000 in 1952 alone. Many historians consider the eradication of polio in the United States the greatest medical breakthrough of the 20th century. As recently as 1988, polio infected 350,000 individuals worldwide. In 2001, the World Health Organization documented only 483 cases thanks to vaccination.
The history of the treatment of polio is one of the great triumphs resulting from the collaboration of industry and consultants to improve medical care. Jonas Salk, MD, and Albert Sabin, MD, usually receive the credit for developing the polio vaccine, but the first true vaccine was developed by Polish immigrant Hilary Koprowski, MD. He worked with Lederle Laboratories, the pharmaceutical division of American Cyanamid. In 1950, the first child was injected with Dr. Koprowski’s attenuated live virus vaccine, and his research led to the development of Dr. Salk’s injected inactivated poliovirus. In addition, Dr. Sabin received the poliovirus from Dr. Koprowski that was eventually developed into the oral attenuated poliovirus vaccine that became the standard treatment worldwide and has nearly eliminated the occurrence of polio.
Innovations and Collaboration
Certainly, a great majority of innovations in ophthalmology are thanks to the collaboration of industry and physicians. The invention of phacoemulsification by Charles Kelman, MD, in 1967 is a classic example. Dr. Kelman worked with industry to develop the Kelman-Cavitron device, which has been refined and improved by two generations of consultants and industry working together. All of these advances have directly benefitted patients.
The US health care system is the finest in the world in large part due to the teamwork of industry and physicians. Members of the ophthalmic industry cannot operate in a vacuum. They need the clinical wisdom, spark of innovation, and experience with patients that only consulting physicians can provide. Medical practitioners understand the shortcomings of present technology and the unmet needs that should be addressed. Conversely, clinicians need industry. Taking an extraordinary idea from conception through prototypes, clinical development, and the maze that is an FDA trial requires organizational skill, leadership, infrastructure, and tens of millions of dollars to complete. Even then, the chances of success are limited. Industry assumes a level of risk that would discomfit most physicians.
Capitalism Exists for a Reason
I am a firm believer in capitalism. It is the dominant economic system in the world for a very good reason: it is a consistent source of innovation. Rewarding anyone from an individual to a multinational company for its ideas and hard work is the cornerstone of the United States’ success. The cooperation of industry and consulting physicians is a prime example of capitalism at its best. Stymieing this partnership ignores a basic premise of capitalism and virtually guarantees the stagnation of medical care and a slide toward mediocrity.
There is hope. Recently, the FDA agreed to allow consultants who are the true experts to serve on their panel meetings, and Harvard University has broken from other institutions and allows faculty members to serve as consultants to industry.
Usually, consultants are superb surgeons with strong clinical backgrounds and the expertise to enable them to advise companies to make better products, perform research, and improve treatment regimens. The single reason why industry wants to work with consultants is because they provide value—again, capitalism at its best. Yes, consultants are compensated for their time and effort but often for less than they would have earned if they had stayed in the office. Most of the consultants I know are the best and brightest in ophthalmology. Overall, they have spent decades honing their expertise and often volunteering their time to train residents and fellows.
I am concerned that companies will no longer support ophthalmologists’ educational events. Continuing education and interactions among physicians are essential in this profession, and corporate support has been vital. With fewer educational opportunities for physicians, patients’ care will suffer.
Virtually every major advance in ophthalmology—phacoemulsification, foldable IOLs, lasers (the Nd:YAG, excimer, and femtosecond), and most pharmaceutical agents — has been developed, refined, and brought to market through close relationships between industry and consulting physicians. This symbiosis should be celebrated, embraced, and fostered for the sake of its ultimate beneficiaries, the patients.
For now, all ophthalmologists must pay attention to the new rules, and in this spirit, I close by saying that I am a consultant—and proud of it.
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