Healthy Skepticism Library item: 19456

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Electronic Source

Silverman E
Conflicts Of Interest & Treatment Guideline Panels
Pharmalot 2011 Mar 29
http://www.pharmalot.com/2011/03/conflicts-of-interest-treatment-guideline-panels/

Full text:

Yet another study has found a conflict of interest among doctors. This time, conflicts were reported by 56 percent of 498 docs who helped write 17 guidelines for the American Heart Association and American College of Cardiology between 2003 through 2008, according to the study published today in the Archives of Internal Medicine (see the abstract). And this finding matters because these panels typically wield considerable influence.
“Panels are the select groups of experts who are assigned to evaluate science independently and issue their advice to other doctors on what to do in clinical practice,” the researchers write. Guidelines “play an important role in synthesizing information for clinicians, as well as increasing uniform practice to certain standards and avoiding the uncontrolled use of medications, procedures, and devices for unproven indications. As such, guidelines are often the vehicle through which clinical trial data are translated into clinical practice.”
They examined the 17 most recent ACC and AHA guidelines and, using disclosure lists, cataloged conflicts for each participant who received a research grant, was on a speaker’s bureau, received honoraria, owned stock, or was a consultant or advisory board member. They found that being a consultant or advisory board member was the most common conflict. Among the companies cited most often were Medtronic, Merck, Bristol-Myers Squibb and Pfizer. And a minority of guidelines required individuals to provide dollar amounts or rate the conflict as “modest” or “significant,” most often using a $10,000 cutoff.
In a joint statement, the ACC and AHA maintain they have tightened their conflict rules to “align with recommendations from the Council of Medical Specialty Societies, which require most panelists who are writing guidelines to be free of conflicts. Thus, the data within and the conclusions drawn by the article do not reflect the reality of the guidelines development process today,” the organizations say (read this). The ACC and AHA also insist their guidelines are “almost perfectly aligned” with recommendations made last week in a report on guidelines from the Institute of Medicine (read here).
AHA president Ralph Sacco, who chairs the neurology department at the University of Miami Medical Schools, believes the study results are important, but argued that requiring divestiture could limit the number of experts available to work on guidelines. “What becomes difficult is some of the experts out there who are well regarded in their field have often conducted research, and some research on devices and drugs is sponsored by companies,” he tells The New York Times.
Nonetheless, critics say the study underscores a need for more change. In an accompanying editorial, Cleveland Clinic cardiovascular chair and former ACC president Steve Nissen, writes that conflicts should largely be banned. “The deliberations in writing guidelines take place in secret. In fact, current policies of professional societies forbid participants in writing groups from disclosing the internal deliberations of the committee. A preliminary version is not posted for public comment,” he writes. ”
“Accordingly, we will never know the extent to which financial relationships affected the internal discussion and deliberations leading to the final recommendations. For committees to be truly independent and respected, even the appearance of impropriety must be avoided. For the public, congressional oversight committees, and the media, a promotional speaker and stockholder is inherently biased and should never be permitted to serve as a guideline writer.”