Study Says Clinical Guides Often Hide Ties of Doctors

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http://www.nytimes.com/2002/02/06/health/06DRUG.html

February 6, 2002

Study Says Clinical Guides Often Hide Ties of Doctors

By SHERYL GAY STOLBERG

WASHINGTON, Feb. 5 - A survey of medical experts who write guidelines for

treating conditions like heart disease, depression and diabetes has found

that nearly 9 out of 10 have financial ties to the pharmaceutical industry,

and the ties are almost never disclosed.

It has long been known that contact with the pharmaceutical industry can

influence individual doctors' prescribing patterns and that financial

support from drug manufacturers can affect the course of academic research.

But the survey, a relatively small study conducted by a team from the

University of Toronto, is the first to document the extent to which the

industry may influence so-called clinical practice guidelines. These

voluntary guidelines, which are typically published in medical journals and

endorsed by medical societies, set standards that are followed by countless

doctors.

" These clinical protocols should be seen by the public as unbiased, " said

Sheldon Krimsky, a health policy expert at Tufts University who has written

extensively on financial conflicts of interest. " The fact that there is a

veil of secrecy over most of these does not bode well for a clinical

community which is trying to ensure trust in the public. "

The survey, in this week's issue of The Journal of the American Medical

Association, sought the opinions of 192 medical experts who participated in

writing 44 sets of practice guidelines covering treatment for asthma,

coronary artery disease, depression, diabetes, high cholesterol, pneumonia

and other ailments.

Of the 100 who responded, roughly 9 out of 10 had some type of financial

relationship with a drug manufacturer, including research financing and

speaking, travel or consulting fees. About 6 out of 10 had financial ties to

companies whose drugs were either considered or recommended in the

guidelines they wrote.

Eleven of the 44 practice guidelines were underwritten by pharmaceutical

companies and carried declarations stating so. But of the 44 guidelines,

just one reported a potential conflict of interest.

" That's a problem, " said Dr. Blumenthal, a health policy expert at

Harvard Medical School who has written about financial conflicts in the

medical profession. " This is just emblematic of the extensive, often

undisclosed relationships that exist between medical experts and

pharmaceutical companies. "

Financial conflicts of interest are the subject of intense debate in

medicine. Pharmaceutical companies often underwrite the cost of medical

conferences and hire prominent academic doctors to serve as speakers or to

lead symposiums at which the companies' drugs are discussed.

Proponents say the companies are helping to educate doctors. But critics

have complained that such financial relationships jeopardize the integrity

of scientific research. This week, more than two dozen prominent scientists

and doctors sent a letter to more than 200 scientific journals urging them

to strengthen their requirements for disclosing conflicts of interest.

Among those who signed is Dr. Marcia Angell, the former editor of The New

England Journal of Medicine. In an interview today, Dr. Angell said that

disclosing financial ties to industry was the least doctors could do and

added that in most cases, the ties should be simply severed.

" Most consulting arrangements are simply a way for researchers to make money

and the industry to buy their good will, " Dr. Angell said. " Researchers

serve on advisory boards and speakers' boards, and they travel around the

world, ostensibly to educational programs. But really, they are just

enriching themselves, and the drug companies retain influence over them to a

remarkable extent. "

Others, including Dr. Allan S. Detsky, an author of the Toronto study, take

a less stringent view, arguing that conflicts should be made public and that

doctors should discuss them openly before writing guidelines.

" It's not possible to stamp this out, " Dr. Detsky said. " The answer is to

sensitize people to accept that it's a problem. "

Only 7 percent of the doctors in the Toronto study said they believed that

their relationships with industry influenced their recommendations, although

19 percent said financial ties influenced the recommendations of their

colleagues.

A spokesman for the Pharmaceutical Research and Manufacturers Association,

an industry trade group, said today that the organization was not opposed to

doctors' disclosing their ties with industry.

But the spokesman, Jeff Trewhitt, said drug companies did not want to see

doctors with drug industry ties excluded from writing guidelines.

" Too many exclusions would mean not allowing some well-respected experts to

work on these important guidelines, " Mr. Trewhitt said.