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20-12-2012 | Article

Disclosure lax in treatment guideline panels


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medwireNews: An investigation of 20 clinical practice guidelines for conditions treated with the 25 top-selling drugs in the USA has revealed that a high proportion of panel doctors had financial ties to drug companies that could skew their recommendations.

More than 80% of the doctors in nine panels had financial ties to drug companies, while four panels did not require members to disclose conflicts of interest. Of the 16 guideline committees that had mandatory disclosure rules, two-thirds of the panel members had ties to drug companies.

"We have not done a good job in ensuring that guidelines are done with the kind of independence and integrity that the public expects," Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic (Ohio), told medwireNews.

Nissen was careful to distinguish doctors who have research relationships with pharmaceutical industries from individuals who give, for example, marketing talks for a company and "cross the line that would exclude them from guideline committees."

The Milwaukee Journal Sentinel and MedPage Today study also found that conflicted panels at times recommended "inappropriate" over-prescribing, especially for anemia, chronic pain, and asthma.

The drugs in the investigation equated to $ 94 billions' worth of sales - or 30% of all US drug profits - in 2011. They included esomeprazole for acid reflux, atorvastatin for high cholesterol, and oxycodone for pain.

The Institute of Medicine (IOM) has advised that participants with conflicts of interest should be excluded from guideline panels whenever possible, and where included make up less than half of the committee with the fullest possible disclosure. The chair or co-chairs of a panel can have no financial conflicts if they are to occupy what Nissen described as "a very powerful position."

The analysis found that only two committees satisfied IOM panel criteria, while at least 10 panels had chairmen with financial ties to drug companies.

"Guidelines are used by everybody [and] determine the standard approach in medicine." Nissen observed. "They have to be beyond reproach. Unfortunately, they are not. Even the appearance of impropriety undermines the guidelines."

Sheldon Greenfield, co-director of the Health Policy Research Institute of California, observed that many experts believe they can transcend bias or would not succumb to a specific prejudice because of working with several drug companies at once. "We now know that none of us can resist [bias]," he told medwireNews. "Just getting a mug or a pizza [from a company] influences us even though we hate to think that it does."

By Peter Sergo, medwireNews Reporter