By Gary Schwitzer
How prevalent are financial conflicts of interest among people writing clinical practice guidelines in Canada and the U.S.?
An analysis published in the BMJ of 14 such guidelines reports:
Among the 288 panel members, 138 (48%) reported
conflicts of interest at the time of the publication of the guideline
and 150 (52%) either stated that they had no such conflicts or did not
have an opportunity to declare any. Among 73 panellists who formally
declared no conflicts, 8 (11%) were found to have one or more. Twelve of
the 14 guideline panels evaluated identified chairs, among whom six had
financial conflicts of interest. Overall, 150 (52%) panel members had
conflicts, of which 138 were declared and 12 were undeclared. Panel
members from government sponsored guidelines were less likely to have
conflicts of interest compared with guidelines sponsored by
non-government sources (15/92 (16%) v 135/196 (69%); P<0.001).
Conclusions: The prevalence of financial conflicts of interest and
their under-reporting by members of panels producing clinical practice
guidelines on hyperlipidaemia or diabetes was high, and a relatively
high proportion of guidelines did not have public disclosure of
conflicts of interest. Organisations that produce guidelines should
minimise conflicts of interest among panel members to ensure the
credibility and evidence based nature of the guidelines’ content.
Item #2:
On his Cardiobrief blog, Larry Husten writes:
An "expert panel" assembled by the National Lipid
Association (NLA) is recommending a dramatic expansion in the use of new
biomarkers for the diagnosis and management of cardiovascular disease.
The recommendations, if widely adopted, would significantly increase not
just the use of these diagnostic tests but also lead to much greater
use of lipid-lowering drugs. But every member of the panel has extensive
ties to industry, and the "consensus conference" that led to
publication of the guidelines was funded by an array of diagnostic and
drug companies that stand to gain from the new recommendations.
Item #3:
Read about
former U.S. Senate Finance Committee Investigator Paul Thacker’s
lecture at Harvard Law School, in which he said that big pharmaceutical
dollars not only own physicians but also many prominent medical school
faculty who are paid to lobby for drugs.
"There’s this sort of idea — an implied
understanding — that doctors belong to us. But that’s often not the
case," Thacker said. Doctors’ dependence on industry money to build and
sustain lucrative practices, Thacker adds, troubles the doctor-patient
dynamic.
"Why did we care about big pharmacy on the finance committee? Because
the federal government pays for one-third of the drugs in the United
States; they are the industry’s largest customer."
A video of the lecture is also available at the link above.
Item #4
From ProPublica:
Under last year’s Affordable Care Act, rules forcing drug and
medical device companies to disclose their gifts, fees and payments to
doctors must be drafted no later than October 1, 2011. That deadline,
however, has come and gone quietly, ProPublica’s Marian Wang writes, and
with little explanation from the Obama administration.