Study Finds Conflicts Among Panels’ Doctors

[Guest guest]

http://www.nytimes.com/2011/03/29/health/29ethics.html?ref=health

March 28, 2011

Study Finds Conflicts Among Panels’ Doctors

By DUFF

WILSON

Doctors with private financial conflicts of interest dominated

some of the panels that wrote guidelines on cardiovascular

health in recent years, according to a medical journal study

released on Monday.

The guideline 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

guidelines influence medical care, product choice, insurance

coverage, government policy and malpractice cases.

The

study, published in the Archives of Internal Medicine,

found that conflicts of interest were reported by 56 percent of

498 people who helped write 17 guidelines for the American

Heart Association and American College of Cardiology, from

2003 through 2008.

Of people who led those groups, an even higher rate — 81

percent — had personal financial interests in companies affected

by their guidelines, the study found.

In a related commentary in the

journal, Dr. E. Nissen, chairman of cardiovascular

medicine at the Cleveland

Clinic and a former president of the American College of

Cardiology, called for banning most of those conflicts rather

than just disclosing them.

In a joint statement on Monday, the cardiology and heart

associations said that they had tightened their

conflict-of-interest controls in 2010 to align with

recommendations from the Council

of Medical Specialty Societies. They now require that the

people leading the group and a majority of members of any

guideline-writing group be free of conflicts of interest.

Dr. N. Kirkpatrick, the study’s senior author, said its

most important finding may be that 44 percent of guideline

writers actually had no financial interests in the area they

reviewed. That rebuts the argument that there are not enough

experienced experts who are independent, he said.

“The conflicts are quite prevalent, but they’re by no means

ubiquitous,” Dr. Kirkpatrick, an assistant professor of medicine

at the Hospital of the University

of Pennsylvania, said in an interview about the research,

which was led by Dr. Todd B. Mendelson, now in residency at the

University

of Pittsburgh.

J. Rothman, a professor and president of the Institute on

Medicine as a Profession at Columbia

University, said the study shows an overdue need for

change.

“The guy who’s calling balls and strikes should not be a

shareholder in one of the teams,” Dr. Rothman said. “It’s so

self-evident that if you’re going to be doing guidelines, it

should be clean. What’s amazing is that it hasn’t been

accomplished yet.”

Dr. Kirkpatrick said the study focused on cardiology because of

its many guidelines and thorough disclosure requirements. Dr.

Rothman, who was not involved in the study, said that it was

also known that cardiologists, along with psychiatrists

and orthopedic physicians, have been well-known for taking

industry gifts, honoraria, consulting and speaking engagements.

The American Heart Association and American College of

Cardiology statement also said their new policies were “almost

perfectly aligned” with an Institute

of Medicine report last week. That report proposed the

strictest rules yet for what it called “standards for developing

trustworthy clinical practice guidelines.”

But the institute, the health arm of the National

Academy of Sciences, went further than the heart groups.

It not only proposed banning conflicts by chairmen and a

majority of members, but it said panelists and their family

members should divest themselves of financial investments and

never participate in marketing activity or advisory boards for

affected companies.

Dr. Ralph L. Sacco, president of the American Heart

Association, said his group applauded the journal’s study and

institute’s recommendations. But he said 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,” Dr. Sacco, chairman of neurology at the University

of Miami medical school, said in an interview Monday.

That includes himself. Dr. Sacco said he ended his own role in

a pharmaceutical company’s research project when he became

president-elect of the heart association, a move required by its

top officers.

[Guest guest]

http://www.nytimes.com/2011/03/29/health/29ethics.html?ref=health

March 28, 2011

Study Finds Conflicts Among Panels’ Doctors

By DUFF

WILSON

Doctors with private financial conflicts of interest dominated

some of the panels that wrote guidelines on cardiovascular

health in recent years, according to a medical journal study

released on Monday.

The guideline 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

guidelines influence medical care, product choice, insurance

coverage, government policy and malpractice cases.

The

study, published in the Archives of Internal Medicine,

found that conflicts of interest were reported by 56 percent of

498 people who helped write 17 guidelines for the American

Heart Association and American College of Cardiology, from

2003 through 2008.

Of people who led those groups, an even higher rate — 81

percent — had personal financial interests in companies affected

by their guidelines, the study found.

In a related commentary in the

journal, Dr. E. Nissen, chairman of cardiovascular

medicine at the Cleveland

Clinic and a former president of the American College of

Cardiology, called for banning most of those conflicts rather

than just disclosing them.

In a joint statement on Monday, the cardiology and heart

associations said that they had tightened their

conflict-of-interest controls in 2010 to align with

recommendations from the Council

of Medical Specialty Societies. They now require that the

people leading the group and a majority of members of any

guideline-writing group be free of conflicts of interest.

Dr. N. Kirkpatrick, the study’s senior author, said its

most important finding may be that 44 percent of guideline

writers actually had no financial interests in the area they

reviewed. That rebuts the argument that there are not enough

experienced experts who are independent, he said.

“The conflicts are quite prevalent, but they’re by no means

ubiquitous,” Dr. Kirkpatrick, an assistant professor of medicine

at the Hospital of the University

of Pennsylvania, said in an interview about the research,

which was led by Dr. Todd B. Mendelson, now in residency at the

University

of Pittsburgh.

J. Rothman, a professor and president of the Institute on

Medicine as a Profession at Columbia

University, said the study shows an overdue need for

change.

“The guy who’s calling balls and strikes should not be a

shareholder in one of the teams,” Dr. Rothman said. “It’s so

self-evident that if you’re going to be doing guidelines, it

should be clean. What’s amazing is that it hasn’t been

accomplished yet.”

Dr. Kirkpatrick said the study focused on cardiology because of

its many guidelines and thorough disclosure requirements. Dr.

Rothman, who was not involved in the study, said that it was

also known that cardiologists, along with psychiatrists

and orthopedic physicians, have been well-known for taking

industry gifts, honoraria, consulting and speaking engagements.

The American Heart Association and American College of

Cardiology statement also said their new policies were “almost

perfectly aligned” with an Institute

of Medicine report last week. That report proposed the

strictest rules yet for what it called “standards for developing

trustworthy clinical practice guidelines.”

But the institute, the health arm of the National

Academy of Sciences, went further than the heart groups.

It not only proposed banning conflicts by chairmen and a

majority of members, but it said panelists and their family

members should divest themselves of financial investments and

never participate in marketing activity or advisory boards for

affected companies.

Dr. Ralph L. Sacco, president of the American Heart

Association, said his group applauded the journal’s study and

institute’s recommendations. But he said 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,” Dr. Sacco, chairman of neurology at the University

of Miami medical school, said in an interview Monday.

That includes himself. Dr. Sacco said he ended his own role in

a pharmaceutical company’s research project when he became

president-elect of the heart association, a move required by its

top officers.

[Guest guest]

http://www.nytimes.com/2011/03/29/health/29ethics.html?ref=health

March 28, 2011

Study Finds Conflicts Among Panels’ Doctors

By DUFF

WILSON

Doctors with private financial conflicts of interest dominated

some of the panels that wrote guidelines on cardiovascular

health in recent years, according to a medical journal study

released on Monday.

The guideline 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

guidelines influence medical care, product choice, insurance

coverage, government policy and malpractice cases.

The

study, published in the Archives of Internal Medicine,

found that conflicts of interest were reported by 56 percent of

498 people who helped write 17 guidelines for the American

Heart Association and American College of Cardiology, from

2003 through 2008.

Of people who led those groups, an even higher rate — 81

percent — had personal financial interests in companies affected

by their guidelines, the study found.

In a related commentary in the

journal, Dr. E. Nissen, chairman of cardiovascular

medicine at the Cleveland

Clinic and a former president of the American College of

Cardiology, called for banning most of those conflicts rather

than just disclosing them.

In a joint statement on Monday, the cardiology and heart

associations said that they had tightened their

conflict-of-interest controls in 2010 to align with

recommendations from the Council

of Medical Specialty Societies. They now require that the

people leading the group and a majority of members of any

guideline-writing group be free of conflicts of interest.

Dr. N. Kirkpatrick, the study’s senior author, said its

most important finding may be that 44 percent of guideline

writers actually had no financial interests in the area they

reviewed. That rebuts the argument that there are not enough

experienced experts who are independent, he said.

“The conflicts are quite prevalent, but they’re by no means

ubiquitous,” Dr. Kirkpatrick, an assistant professor of medicine

at the Hospital of the University

of Pennsylvania, said in an interview about the research,

which was led by Dr. Todd B. Mendelson, now in residency at the

University

of Pittsburgh.

J. Rothman, a professor and president of the Institute on

Medicine as a Profession at Columbia

University, said the study shows an overdue need for

change.

“The guy who’s calling balls and strikes should not be a

shareholder in one of the teams,” Dr. Rothman said. “It’s so

self-evident that if you’re going to be doing guidelines, it

should be clean. What’s amazing is that it hasn’t been

accomplished yet.”

Dr. Kirkpatrick said the study focused on cardiology because of

its many guidelines and thorough disclosure requirements. Dr.

Rothman, who was not involved in the study, said that it was

also known that cardiologists, along with psychiatrists

and orthopedic physicians, have been well-known for taking

industry gifts, honoraria, consulting and speaking engagements.

The American Heart Association and American College of

Cardiology statement also said their new policies were “almost

perfectly aligned” with an Institute

of Medicine report last week. That report proposed the

strictest rules yet for what it called “standards for developing

trustworthy clinical practice guidelines.”

But the institute, the health arm of the National

Academy of Sciences, went further than the heart groups.

It not only proposed banning conflicts by chairmen and a

majority of members, but it said panelists and their family

members should divest themselves of financial investments and

never participate in marketing activity or advisory boards for

affected companies.

Dr. Ralph L. Sacco, president of the American Heart

Association, said his group applauded the journal’s study and

institute’s recommendations. But he said 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,” Dr. Sacco, chairman of neurology at the University

of Miami medical school, said in an interview Monday.

That includes himself. Dr. Sacco said he ended his own role in

a pharmaceutical company’s research project when he became

president-elect of the heart association, a move required by its

top officers.

[Guest guest]

http://www.nytimes.com/2011/03/29/health/29ethics.html?ref=health

March 28, 2011

Study Finds Conflicts Among Panels’ Doctors

By DUFF

WILSON

Doctors with private financial conflicts of interest dominated

some of the panels that wrote guidelines on cardiovascular

health in recent years, according to a medical journal study

released on Monday.

The guideline 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

guidelines influence medical care, product choice, insurance

coverage, government policy and malpractice cases.

The

study, published in the Archives of Internal Medicine,

found that conflicts of interest were reported by 56 percent of

498 people who helped write 17 guidelines for the American

Heart Association and American College of Cardiology, from

2003 through 2008.

Of people who led those groups, an even higher rate — 81

percent — had personal financial interests in companies affected

by their guidelines, the study found.

In a related commentary in the

journal, Dr. E. Nissen, chairman of cardiovascular

medicine at the Cleveland

Clinic and a former president of the American College of

Cardiology, called for banning most of those conflicts rather

than just disclosing them.

In a joint statement on Monday, the cardiology and heart

associations said that they had tightened their

conflict-of-interest controls in 2010 to align with

recommendations from the Council

of Medical Specialty Societies. They now require that the

people leading the group and a majority of members of any

guideline-writing group be free of conflicts of interest.

Dr. N. Kirkpatrick, the study’s senior author, said its

most important finding may be that 44 percent of guideline

writers actually had no financial interests in the area they

reviewed. That rebuts the argument that there are not enough

experienced experts who are independent, he said.

“The conflicts are quite prevalent, but they’re by no means

ubiquitous,” Dr. Kirkpatrick, an assistant professor of medicine

at the Hospital of the University

of Pennsylvania, said in an interview about the research,

which was led by Dr. Todd B. Mendelson, now in residency at the

University

of Pittsburgh.

J. Rothman, a professor and president of the Institute on

Medicine as a Profession at Columbia

University, said the study shows an overdue need for

change.

“The guy who’s calling balls and strikes should not be a

shareholder in one of the teams,” Dr. Rothman said. “It’s so

self-evident that if you’re going to be doing guidelines, it

should be clean. What’s amazing is that it hasn’t been

accomplished yet.”

Dr. Kirkpatrick said the study focused on cardiology because of

its many guidelines and thorough disclosure requirements. Dr.

Rothman, who was not involved in the study, said that it was

also known that cardiologists, along with psychiatrists

and orthopedic physicians, have been well-known for taking

industry gifts, honoraria, consulting and speaking engagements.

The American Heart Association and American College of

Cardiology statement also said their new policies were “almost

perfectly aligned” with an Institute

of Medicine report last week. That report proposed the

strictest rules yet for what it called “standards for developing

trustworthy clinical practice guidelines.”

But the institute, the health arm of the National

Academy of Sciences, went further than the heart groups.

It not only proposed banning conflicts by chairmen and a

majority of members, but it said panelists and their family

members should divest themselves of financial investments and

never participate in marketing activity or advisory boards for

affected companies.

Dr. Ralph L. Sacco, president of the American Heart

Association, said his group applauded the journal’s study and

institute’s recommendations. But he said 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,” Dr. Sacco, chairman of neurology at the University

of Miami medical school, said in an interview Monday.

That includes himself. Dr. Sacco said he ended his own role in

a pharmaceutical company’s research project when he became

president-elect of the heart association, a move required by its

top officers.