A study that appears in the March 28, 2013, issue of the Archives of Internal Medicine shows that more than half of the nearly 500 writers and reviewers of recent cardiology clinical practice guidelines reported a conflict of interest due to ties with drug makers and other companies. That doesn’t sound like a very good percentage, even when those conflicts are reported and made with full disclosure, and in reality, it isn’t.
The findings are troubling because clinical practice guidelines (CPGS) are often adopted as the standard of care and taught in medical training programs, according to background information in the study. Researchers examined the 17 most recent American College of Cardiology/American Heart Association clinical practice guidelines issued through 2008. Of the 498 people involved in creating those guidelines, 277 (56 percent) reported a conflict of interest. The most common types of conflict of interest that were reported are:
• being a consultant or member of an advisory board;
• receiving a research grant;
• being on a speaker’s bureau and/or receiving honoraria; and
• owning stock.
Dr. Todd B. Mendelson of the University of Pennsylvania in Philadelphia and his colleagues wrote:
Our finding that most episodes of guidelines participation involve conflicts of interest, and that most individuals involved in producing guidelines report conflicts, is a cause for concern. These findings are a particular cause for concern given the fact that many of the newest ACC/AHA guideline recommendations are based more on expert opinion than on clinical trial data.
The findings “raise disturbing questions about the independence and reliability of CPGs in cardiovascular medicine,” Dr. Steven E. Nissen of the Cleveland Clinic Foundation wrote in an accompanying commentary. Our Mass Torts lawyers have seen evidence of conflicts of interest throughout the years in our ongoing battle with “Big Pharma.” The fact that the drug industry is influencing medical decisions with financial or other support to experts in this field comes as no surprise.
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