322

CANADIAN JOURNAL OF ANESTHESIA

Correspondence Shocked and appalled1 To the Editor: I would like to record a rather awkward observation and raise a question concerning academic anesthesia. My recently received copy of the Canadian Journal of Anesthesia (Vol. 52, no. 7, August/September 2005), seemed to open automatically to reveal a ten-page glossy section, with better than average quality paper, entitled “2005 Research Grants, Career Scientist and Fellowship Program”. It was well designed, attractive, informative, appearing in both French and English. Obviously, this program is heavily dependent on the pharmaceutical industry. Of the12 annual awards described, eight are clearly supported by industry, with award names identifying the sponsors. Award values range between $10,000 and $270,000 representing a cumulative amount exceeding $500,000 annually. All the recipients listed for 2005 program are members of Canadian University Departments of Anesthesia in Canada, and the recipient of the Resident’s Research Award resident is (was) a registered postgraduate student. I recognize that around 1968 the 16 (now 17) Canadian Universities with medical schools became partners with the Royal College of Physicians and Surgeons in the education and training of specialists in medicine (I was there), and later, with the College of Family Practice. But now apparently, through the above enclosure in the Canadian Journal of Anesthesia, I am being informed on the last page that: “The Canadian Anesthesiologists’ Society gratefully acknowledges the continued support of the Canadian Anesthesia Research Foundation and our industry partners”. Since all this substantial financial support is received either by faculty or residents in university departments, then are university departments also in partnership with the pharmaceutical industry? Has anyone ever asked the question? This is neither a small nor insignificant matter, witness recent medical-academic/industry legal battles. Is this more evidence in support of the recently published book: “On the Take: How Medicine’s Complicity with Big Business can Endanger Your Health” by Jerome P. Kassirer, MD (former Editor, New England Journal of Medicine) Oxford University Press 2005? CAN J ANESTH 2006 / 53: 3 / pp 322–328

Stuart L. Vandewater MD FRCPC Kingston, Canada E-mail:[email protected] Accepted for publication November 21, 2005. Reference 1 Kapica J. Shocked and Appalled: A Century of Letters to the Globe and Mail. Lester & Orpen Denys; 1985.

Reply: As Chair of the Canadian Anesthesiologists’ Society (CAS) Research Committee, I welcome the opportunity to address the issues raised by Dr. Vandewater regarding industry partners as sponsors of the CAS Research Grants, Career Scientist, and Fellowship Program. “partner: a country, organization, etc. that has an agreement with another or others”.1 The CAS has formal agreements with the corporate sponsors that support the CAS Research Program. As well, all recipients of the awards comprising this program enter into agreements with the CAS pertaining to each award. To answer Dr. Vandewater’s question – the CAS is indeed in partnership with corporate sponsors of the CAS Research Grants Program, and, in turn, the recipients of these awards, become partners with the CAS. However, according to the above definition, award recipients and their Departments are not in partnership with the corporate sponsors of the CAS Research Program. I believe the veracity of this conclusion is reinforced by the manner in which the CAS manages its Research Program. The Canadian Anesthesia Research Foundation (CARF) accepts donations from corporate sponsors, as well as individual donors. Each year, the CARF Board of Directors informs the CAS of the amount of funding available for each of the awards. However, neither the donors (corporate or other) nor the Board of the CARF are involved in the selection of award recipients. The CAS Research Committee is responsible for assessing the applications, using a peerreview process similar to other non-profit granting agencies. Applications are reviewed by anesthesiologists with research expertise from across Canada. The applications and these reviews are subsequently carefully considered by the Research Committee, which then makes final recommendations to the CAS Board of Directors regarding

323

CORRESPONDENCE

the recipients of each of the awards. Donors to CARF do not have any input into the conduct of research by award recipients, nor do they have any influence on the publication of scientific papers by those recipients. The policies ensure that recipients of CAS Research Awards and their research activities remain independent of the donors and sponsors of this program. The CAS Research Program is the largest provider of funds for Canadian anesthesia research. Without the good corporate citizenship of its industry sponsors, and the institutional matching funds required for the Career Scientist Awards, the CAS Research Program could not help to ensure stable and ongoing support of anesthesia research in Canada. For 2004, corporate donations to CARF amounted to $350,000, while individual donations (largely from CAS members) totaled less than $50,000 (personal communication, Dr. R. Byrick). No one should appreciate the value of anesthesiology research more than anesthesiologists. Here is my challenge: if each of us donated the equivalent of one hour of our clinical earnings, we could increase research funding by about 100%. For information about donating to the CARF, visit www.anesthesia.org/carf. My cheque is in the mail. How about yours? Robert J. Hudson MD FRCPC Chair, CAS Research Committee Member, CARF Board of Directors University of Alberta, Edmonton, Canada E-mail: [email protected] Reference 1 Barber K. The Canadian Oxford Dictionary. Toronto: Oxford University Press; 1998.

Clinical evaluation of near-infrared spectroscopy To the Editor: I read with great interest the paper published by Taillefer and Denault1 “Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy”. In my view, the citations present a biased selection of articles on near-infrared spectroscopy (NIRS), because the search presented mainly articles describing the use of Somanetics™ devices (INVOS® Cerebral Oximeter, Somanetics Corporation, Troy, MI, USA). It would not be surprising that Somanetics™ would include positive results of investigations of their device in their reference list. The Hamamatsu™ devices (NIRO 1000, 500, 300, 200, Infrared Oxygenation Monitors NIRO Series,

Hamamatsu Photonics K.K., Hamamatsu, Japan) do not have the Food and Drug Administration approval; however they have been used frequently. Tamura et al.2 published the first clinical report on NIRS monitoring in coronary artery bypass patients in 1994; I published two reports in the same patient population in 1995.3,4 The omission of these studies and others5 suggests that the database for the systematic review of Taillefer and Denault may have been incomplete. Interestingly, there are very few articles on animal studies using the Somanetics™ device. The principal difficulty with NIRS is its limited value in the setting of hemodilution, and particularly with deep hypothermic circulatory arrest. With decreasing hemoglobin concentration, the optical pathlengths in tissue become longer, because the light is less well absorbed and becomes scattered. However, this phenomenon is wavelength-dependent, and therefore the algorithms for measuring hemoglobin (minor errors) or cytochrome (very large errors) become false. In my opinion, the solution to this problem is to measure absolute pathlength, which is technically challenging but possible. Georg Nollert MD FAHA Siemens Medical Solutions, Munich Germany E-mail: [email protected] Accepted for publication October 26, 2005. References 1 Taillefer MC, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anesth 2005; 52: 79–87. 2 Tamura M. Non-invasive monitoring of brain oxygen metabolism during cardiopulmonary bypass by near-infrared spectrophotometry. Jpn Circ J 1991; 55: 330–5. 3 Nollert G, Mohnle P, Tassani-Prell P, Reichart B. Determinants of cerebral oxygenation during cardiac surgery. Circulation 1995; 92: II327–33. 4 Nollert G, Mohnle P, Tassani-Prell P, et al. Postoperative neuropsychological dysfunction and cerebral oxygenation during cardiac surgery. Thorac Cardiovasc Surg 1995; 43: 260–4. 5 Nollert G, Shin‘oka T, Jonas RA. Near-infrared spectrophotometry of the brain in cardiovascular surgery. Thorac Cardiovasc Surg 1998; 46: 167–75.