Another study is highlighting the potential pitfalls that can occur when doctors maintain close financial ties with drug and medical device makers. According to the study, published in the Archives of Internal Medicine, most of the doctors who have served on panels charged with writing heart treatment guidelines have financial relationships with companies that market medical products. The authors of the study contend that even when such potential conflicts-of-interest are disclosed, bias can still occur.
“Improper bias in the clinical practice guidelines can have a potentially more widespread adverse effect on patient care than individual practitioners’ conflicts of interest,” the study said.
According to The New York Times, medical-practice guideline panels are made up of experts who are assigned to evaluate science independently and issue their advice to other doctors on what to do in clinical practice. The recommendations these panels make will influence, among other things, the drugs and medical devices practitioners ultimately choose for treating patients. According to a report in The Wall Street Journal, such guidelines have become more important as the practice of “evidence-based medicine” has grown.
This study looked at 17 sets of guidelines issued from 2003 through 2008 by the American Heart Association and American College of Cardiology. Overall, 56 percent of 498 people who wrote these guidelines had conflicts. In one instance, the researchers found that of 34 doctors on a 2008 panel to write guidelines on defibrillators and pacemakers, only seven had no financial connection to a related medical company. Eighty-one percent of the people tapped to lead these groups had a conflict, according to the Times.
According to the Journal, Medtronic Inc., a maker of heart devices like internal defibrillators, had the most or was tied for the most financial ties to guideline writers on seven of the 17 heart guideline panels. Drug maker Pfizer Inc. had the most or was tied for the most on four guideline committees.
In most cases, potential conflicts took the form of consultant contracts and research grants, according to the Journal. Three quarters who worked on stroke recommendations had been paid speakers for related companies. About a third of those who wrote guidelines for coronary angioplasty held stock in related medical companies, while 29 percent did so when they wrote about heart-bypass operations.
In a related commentary in the journal, Dr. Steven 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, The New York Times reported.
In a joint statement to the Times, the American Heart Association and American College of Cardiology, said 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. The groups’ contend that their new guidelines are â€œalmost perfectly alignedâ€ with an Institute of Medicine report released last week, which proposed the strictest rules yet. But as the Times points out, the institute did go further than the heart groups, and proposed that panelists and their family members should divest themselves of financial investments and never participate in marketing activity or advisory boards for affected companies.