Too many doctors and researchers who help create guidelines for patient care have financial ties to the pharmaceutical industry, according to a study that investigated conflict of interest among a group of major Canadian and U.S. health care organizations.
More than half of panel members who develop clinical practice guidelines for the treatment of diabetes and high cholesterol — conditions which generated $70 billion in drug sales in 2010 — have received compensation by pharmaceutical companies, the U.S. researchers report. The compensation is in the form of consultancy payments, honorariums, speakers’ fees and research grants.
The study, published online Wednesday in BMJ: The British Medical Journal, found the problem was more serious in Canadian specialty organizations, with 83 per cent of panel members having industry ties. Among the American specialty organizations, 58 per cent of panel members had such ties.
“That indicates there is a potential risk of industry influence on guideline recommendations,” said Dr. Jennifer Neuman, the study’s lead author and instructor in the department of preventive medicine at New York’s Mount Sinai School of Medicine.
“Guidelines serve to standardize care and inform evidence-based practice and ultimately to protect patients. Their freedom from bias is very important.”
The study evaluated 14 sets of clinical care guidelines — three from Canada and 11 from the U.S. — published between 2000 and 2010. The guidelines are a key reference for physicians who screen and treat patients for high cholesterol and diabetes.
The investigators found more than half of those who chaired guideline panels had conflicts. They also found one out of nine panellists who had reported no conflict of interest did have industry ties.
The Canadian Cardiovascular Society, a 2,000-member medical specialty society whose mandate is, among others, to promote cardiovascular health and care through knowledge translation, had the highest prevalence of conflict among organizations included in the study. Every one of their 23 panel members had a conflict of interest — three of which were not declared — at the time the society published its 2009 practice guidelines for high cholesterol.
The Canadian Diabetes Association, the other Canadian specialty organization included in the study, released practice guidelines in 2008. At the time, 73 members of its 93-member panel had industry ties. The Canadian Diabetes Association was not available for comment.
Canadian Cardiovascular Society president Dr. Blair O’Neill said the organization’s process for developing guidelines has been updated in the last few years, specifically to address the issue of conflict.
Each of the society’s panels has two chairs, none of whom has done research funded by industry. And of the remainder of the panel, 50 per cent plus one of the members can have no such ties.
But, O’Neill added, it’s impossible for all of them not to have such ties because the level of expertise would be diluted. He explained that there is a limited pool of experts in Canada to begin with and the best ones inevitably have their research funded by industry because the government funding just isn’t there.
“The experts in the field . . . have done research funded by industry because government granting agencies’ purse strings have become ever tighter,” O’Neill said.
While O’Neill argues that the panels had never been biased in the past, the public should now have full confidence in their work, he said.
Neuman said their study found government sponsored panels had significantly fewer members with conflict of interest, which shows that expert panels can be composed of people without ties to industry.
She said health care organizations must be held to one standard to minimize conflict of interest, and that mandates for panel members to disclose industry ties may not be enough to prevent industry bias from influencing practice guidelines.
Trudo Lemmens, an associate professor at the University of Toronto’s law and medical schools, said more must be done to eliminate real and potential conflicts of interest.
“It’s a question of establishing public trust in the system” said Lemmens, who holds the William M. Scholl chair in health law and policy, in the faculty of law.
“The perception of conflict alone creates doubt about the process. It makes you unsure about the level of independence when making decisions,” he said.
Origin
Source: Health Zone
More than half of panel members who develop clinical practice guidelines for the treatment of diabetes and high cholesterol — conditions which generated $70 billion in drug sales in 2010 — have received compensation by pharmaceutical companies, the U.S. researchers report. The compensation is in the form of consultancy payments, honorariums, speakers’ fees and research grants.
The study, published online Wednesday in BMJ: The British Medical Journal, found the problem was more serious in Canadian specialty organizations, with 83 per cent of panel members having industry ties. Among the American specialty organizations, 58 per cent of panel members had such ties.
“That indicates there is a potential risk of industry influence on guideline recommendations,” said Dr. Jennifer Neuman, the study’s lead author and instructor in the department of preventive medicine at New York’s Mount Sinai School of Medicine.
“Guidelines serve to standardize care and inform evidence-based practice and ultimately to protect patients. Their freedom from bias is very important.”
The study evaluated 14 sets of clinical care guidelines — three from Canada and 11 from the U.S. — published between 2000 and 2010. The guidelines are a key reference for physicians who screen and treat patients for high cholesterol and diabetes.
The investigators found more than half of those who chaired guideline panels had conflicts. They also found one out of nine panellists who had reported no conflict of interest did have industry ties.
The Canadian Cardiovascular Society, a 2,000-member medical specialty society whose mandate is, among others, to promote cardiovascular health and care through knowledge translation, had the highest prevalence of conflict among organizations included in the study. Every one of their 23 panel members had a conflict of interest — three of which were not declared — at the time the society published its 2009 practice guidelines for high cholesterol.
The Canadian Diabetes Association, the other Canadian specialty organization included in the study, released practice guidelines in 2008. At the time, 73 members of its 93-member panel had industry ties. The Canadian Diabetes Association was not available for comment.
Canadian Cardiovascular Society president Dr. Blair O’Neill said the organization’s process for developing guidelines has been updated in the last few years, specifically to address the issue of conflict.
Each of the society’s panels has two chairs, none of whom has done research funded by industry. And of the remainder of the panel, 50 per cent plus one of the members can have no such ties.
But, O’Neill added, it’s impossible for all of them not to have such ties because the level of expertise would be diluted. He explained that there is a limited pool of experts in Canada to begin with and the best ones inevitably have their research funded by industry because the government funding just isn’t there.
“The experts in the field . . . have done research funded by industry because government granting agencies’ purse strings have become ever tighter,” O’Neill said.
While O’Neill argues that the panels had never been biased in the past, the public should now have full confidence in their work, he said.
Neuman said their study found government sponsored panels had significantly fewer members with conflict of interest, which shows that expert panels can be composed of people without ties to industry.
She said health care organizations must be held to one standard to minimize conflict of interest, and that mandates for panel members to disclose industry ties may not be enough to prevent industry bias from influencing practice guidelines.
Trudo Lemmens, an associate professor at the University of Toronto’s law and medical schools, said more must be done to eliminate real and potential conflicts of interest.
“It’s a question of establishing public trust in the system” said Lemmens, who holds the William M. Scholl chair in health law and policy, in the faculty of law.
“The perception of conflict alone creates doubt about the process. It makes you unsure about the level of independence when making decisions,” he said.
Origin
Source: Health Zone
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