How prevalent are financial conflicts of interest among people writing clinical practice guidelines in Canada and the US?
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.
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.
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.
Addendum: 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.