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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.
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.
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.
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.
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.
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.
So, how much industry involvement
should disqualify a doctor from participation in clinical guidelines?
That's the $64,000 question. 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 they can preclude these conflicts from harming the consumer.
JAMA February 6, 2002;287:612-617
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