Medical Panels Are Rife With Financial Conflicts
4 CommentsBy Ed Silverman // October 12th, 2011 // 11:55 am
In 1996, shortly after we began tracking the pharmaceutical industry, we spent time looking at obesity research and the latest diet pills. In doing so, we noticed that a panel that was assembled by the government to develop a guideline for the overweight known as the Body Mass Index. And it was populated by experts, nearly all of whom had a financial tie to a drugmaker selling or developing such pills.
The finding, of course, was not all that new, but the practice continues, according to a new study in BMJ, which examined panels responsible for generating clinical practice guidelines on screening and/or treatment for high cholesterol or diabetes in the US and Canada between 2000 and 2010. A good many of the panelists - and panel chairs - had conflicts of interest. But not all were disclosed.
Specifically, 14 guidelines panel met the criteria for the study and these included 288 panel members. Of these, 48 percent, or 138, reported conflicts at the time guidelines were published, while the other 52 percent, or 150 panelists, either they stated they did not have conflicts or did not have an opportunity to declare they had conflicts.
Drilling down, though, yielded something different. Among 73 panelists who declared they did not have a conflict, eight - or 11 percent - actually did have at least one conflict. Meanwhile, 12 of the 14 guideline panels that were examined found that six panel chairs had financial conflicts of interest. And panel members from government-sponsored guidelines were less likely to have conflicts compared with panels sponsored by other sources - 16 percent versus 69 percent (here is the study and a helpful table).
The conclusion? “The finding that most current members of guideline panels and half of chairs of panels have COI is concerning and suggests that a risk of considerable influence of industry on guideline recommendations exists….The minimization of COI on guideline panels is likely to do far more to mitigate bias than would mere disclosure. The guideline development process needs to be reformed to minimize conflicts of interest among panel members to ensure the credibility and evidence based nature of the clinical practice guidelines issued.”
An accompanying editorial is more pointed. Edwin Gale, a diabetes specialist Southmead Hospital in the UK, writes that “it has been said that ‘it is difficult to get a man to understand something when his salary depends upon his not understanding it,’ and the medical profession has been slow to understand the importance of conflicts of interest…What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette.”
pic thx to Jerome Kassirer
Hat tip to Shots
company insider
I totally agree with Erwin Gale, she is absolutely correct or until their is more concern for the safety of the patient than making money.
My PharmalotID
If this wasn’t so serious, Ed, I would be laughing right now!
This is old news. Anyone who has reviewed the membership roles of FDA advisory committees going back as far as memory serves could have told you this.
Some examples are legend, including the infamous Provenge Advisory Committee of March 29, 2007, when several AC members had conflictions of interest (at least the ones they reported) so outrageous, the people involved never should have been allowed to vote, much less get within a country mile of the meeting room in Bethesda. Just take a look at the article below:
http://www.biocentury.com/biotech-pharma-news/politics/2007-03-26/politics-and-policy-the-price-of-pristine-a16
Read “The price of pristine.”
Even in the cases where COIs are revealed, it’s still possible for Big Pharma and their handmaidens, the Contract Research Organizations (CROs) to ‘hide the pea.’ How? Byusing grants to institutions, for example, that allow the funds to get swallowed up in the operating budget of an AC participant’s department so there is no indication of money flowing direction to him. Voilà! No direct payment, no conflict of interest. Do you want proof? Read the waivers issued by the FDA to AC participants and look at all the ‘grants’ cited. Talk about ‘laundering’ money.
Everyone knows it’s going on. Yet for all the lip service paid to changing the system, and for all the good work of Sen. Chuck Grassley, nothing really has changed.
And so, the FDA remains one of the most corrupt agencies in Washington.
Bernard Carroll
The great sociologist Jane Jacobs put it this way: “There are many fine points to medical ethics, and some difficult puzzles, but the most rudimentary morality is the line between the guardian and commercial (traditions). It’s as crucial that physicians understand it as it is that lawyers recognize that when they go into guardian service they can’t morally also be in service to clients seeking to influence legislation or regulatory decisions.” [Systems of Survival, Random House 1992]
AnnePME
Since physicians are making less money and this has become an accepted practice, it would not surprise me if consultants to other medical areas such as generic drugs, insurance and/or PBMs start or are already on board. The problem is that the names and credentials of these professionals is often a ‘trade secret’, so they would likely be able to bypass any transparency requirements.