Medical Science ? or Medical Fraud .....

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February 05 , 2002 [Reuters]

Most Doctors Who Set Guidelines Have Industry Ties

By Stenson

NEW YORK (Reuters Health) - The vast majority of doctors involved in

establishing national guidelines on disease treatment have financial ties

to the pharmaceutical industry that could potentially sway their

recommendations and inappropriately influence thousands of other

physicians, a new study concludes.

Eighty-seven percent of guideline authors had some type of relationship

with drug companies, yet these often were not disclosed, according to

survey responses from 100 authors of guidelines published from 1991 to 1999

for common diseases such as diabetes, high blood pressure and asthma.

More specifically, 38% of respondents said they had served as employees or

consultants for pharmaceutical companies and 58% had received financial

support for medical research. In addition, 59% had links with drug

companies whose medications were considered in the particular guidelines

they authored, according to the report in the February 6th issue of The

Journal of the American Medical Association.

" The findings show that people who work on committees who write practice

guidelines have lots of financial relationships with companies whose

products they're assessing, " study author Dr. Allan Detsky,

physician-in-chief at Mount Sinai Hospital in Toronto, told Reuters Health.

And these figures may underestimate the problem, the researchers said,

because only 52% of the authors contacted for the survey responded. Some

may have declined to participate because they did not want to disclose

their industry relationships, the report indicates. Though the

investigators did not name names, the survey did not explicitly guarantee

anonymity.

While industry ties don't necessarily mean that a doctor can't provide an

objective opinion, " it's a potential problem, "

Detsky said.

In the study, the researchers did not actually search for concrete examples

in which industry ties translated into improper treatment recommendations.

But when respondents were asked whether relationships with drug companies

influenced guideline recommendations, 19% said they thought their

co-authors' recommendations were swayed by their relationships and 7% said

they thought their own relationships influenced recommendations.

Detsky pointed out that industry relationships are often an essential part

of doing business for doctors. Many of the nation's top medical researchers

at prestigious academic institutions--the same ones sought for guideline

authorship--have industry relationships because it is the pharmaceutical

companies who finance most of the nation's drug research. Detsky himself

has received honoraria for speeches, consulting fees and research grant

money from drug companies.

So how much industry involvement should disqualify a doctor from

participation in clinical guidelines? " That's the $64,000 question, " Detsky

said. " Any cut point would be considered arbitrary with the possible

exception of zero involvement. "

The researchers specifically recommended the disqualification of authors

who own equity in a company whose products are being reviewed in the

guidelines.

Beyond that, each medical group that sets guidelines should devise their

own ways for identifying and dealing with potential conflicts of interest

within their specialty-- " ways we can preclude these conflicts from harming

the consumer, " Detsky said. In the survey, 55% of respondents said the

guidelines they worked on had no formal process for declaring relationships

with drug companies. And just 2 of the 44 guidelines evaluated in the study

listed the authors' industry relationships in print.

SOURCE:

The Journal of the American Medical Association 2002;287:612-617.