New revelations of financial conflicts of interest between physicians and industry seem to be popping up in the news almost every week.
And this week was no exception.
On Wednesday, a team of researchers reported in the journal BMJ on the results of a study that examined conflicts of interest among the physician-experts who serve on Canadian and U.S. panels that determine clinical guidelines.
Clinical guidelines are the recommendations that physicians use to care for their patients. They help physicians decide how often you should be screened for colon cancer, for example, or whether or not you should be taking a drug for high blood pressure.
The results of the BMJ study aren’t reassuring. It found that more than half of the members of 14 panels (11 American; 3 Canadian) that have issued clinical guidelines regarding the screening and prevention of diabetes and high cholesterol during the past decade had financial conflicts of interest.
In other words, a majority of the experts had some kind of monetary tie to a drug or medical-device company — a company that very likely would be affected by the guidelines.
Underestimating the problem
Here are the specific numbers from the BMJ study: The 14 panels had a total of 288 members, of which 150 had conflicts of interest. Most of the panel members with conflicts (138) had publically disclosed their ties to industry. Only 12 hadn’t. (Not all the panels required public disclosure.)
Half of the chairs of the panels had industry ties.
The study may have underestimated the panel members’ conflicts of interest, however. “Our methods were deliberately conservative,” write its authors. “… For example, if a panel member’s spouse was an employee of the drug industry, we did not consider it a conflict.”
Most of the conflicts uncovered in the study occurred on non-governmental panels — ones put together by such specialty organizations as the American Heart Association and the American Diabetes Association. Some 69 percent of the members of those panels had financial ties to industry.
By comparison, only 16 percent of members of government-sponsored panels — groups like the U.S. Preventive Services Task Force and the Veterans Administration — were found to have conflicts of interest.
As the BMJ authors point out, the low rate of conflicts on the government-sponsored panels suggests that panels can be assembled predominantly with experts free of industry ties.
A widespread concern
The authors focused their BMJ study on panels that issue diabetes and high cholesterol guidelines because those two illnesses affect a large number of Americans and because the drugs used to treat those illnesses make up the largest share of prescription drug costs in the United States.
But practice guidelines for other medical conditions are also rife with conflicts of interest. Last spring, a study reported that 56 percent of individual experts who participated in the formation of 17 guidelines for the American College of Cardiology and the American Heart Association had conflicts of interest.
Recognizing the need for unbiased clinical guidelines, the Institute of Medicine (IOM) published new recommendations in 2009 for selecting experts to serve on clinical guidelines panels. The recommendations call for, among other things, the exclusion of panel members with financial conflicts of interests and the end of direct funding of guidelines by industry. (Yes, companies often pay for the guidelines that determine which drugs and devices will become commonly prescribed by physicians.)
The current BMJ study certainly appears to support the need for such recommendations.
“Organisations that produce guidelines should minimize conflicts of interest among panel members to ensure the credibility and evidence based nature of the guidelines’ content,” the BMJ authors conclude.
But will they?
On his Cardiobrief blog Thursday, Larry Husten wrote of the stunning conflicts of interest among the members of a panel convened by the National Lipid Association — a panel that is about to issue “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,” writes Huston. “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.” (Not surprising when the association itself is funded by those companies.)