Medical panelists may have financial conflicts of interest
Doctors with private financial conflicts of interest dominated some of the panels that wrote guidelines on cardiovascular health in recent years, according to a medical journal study released Monday.
The guideline panels are the select groups of experts who are assigned to evaluate science independently and issue their advice to other doctors on what to do in clinical practice. The guidelines influence medical care, product choice, insurance coverage, government policy and malpractice cases.
The study, published in the Archives of Internal Medicine, found that conflicts of interest were reported by 56 percent of 498 people who helped write 17 guidelines for the American Heart Association and American College of Cardiology, from 2003 through 2008.
Of people who led those groups, an even higher rate — 81 percent — had personal financial interests in companies affected by their guidelines, the study found.
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.
In a joint statement Monday, the cardiology and heart associations said that they had tightened their conflict-of-interest controls in 2010 to align with recommendations from the Council of Medical Specialty Societies. 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.
Dr. James N. Kirkpatrick, the study’s senior author, said its most important finding may be that 44 percent of guideline writers actually had no financial interests in the area they reviewed. That rebuts the argument that there are not enough experienced experts who are independent, he said.
“The conflicts are quite prevalent, but they’re by no means ubiquitous,” Kirkpatrick, an assistant professor of medicine at the Hospital of the University of Pennsylvania, said in an interview about the research, which was led by Dr. Todd B. Mendelson, now in residency at the University of Pittsburgh.
David J. Rothman, a professor and president of the Institute on Medicine as a Profession at Columbia University, said the study shows an overdue need for change.
“The guy who’s calling balls and strikes should not be a shareholder in one of the teams,” Rothman said. “It’s so self-evident that if you’re going to be doing guidelines, it should be clean. What’s amazing is that it hasn’t been accomplished yet.”
Kirkpatrick said the study focused on cardiology because of its many guidelines and thorough disclosure requirements. Rothman, who was not involved in the study, said that it was also known that cardiologists, along with psychiatrists and orthopedic physicians, have been well-known for taking industry gifts, honoraria, consulting, and speaking engagements.
The American Heart Association and American College of Cardiology statement also said their new policies were “almost perfectly aligned” with an Institute of Medicine report last week. That report proposed the strictest rules yet for it called “standards for developing trustworthy clinical practice guidelines.”
But the institute, the health arm of the National Academy of Sciences, went further than the heart groups. It not only proposed banning conflicts by chairmen and a majority of members, but it said panelists and their family members should divest themselves of financial investments and never participate in marketing activity or advisory boards for affected companies.
Dr. Ralph L. Sacco, president of the American Heart Association, said his group applauded the journal’s study and institute’s recommendations. But he said requiring divestiture could limit the number of experts available to work on guidelines.
“What becomes difficult is some of the experts out there who are well regarded in their field have often conducted research, and some research on devices and drugs is sponsored by companies,” Sacco, chairman of neurology at the University of Miami medical school, said in an interview Monday.
That includes himself. Sacco said he ended his own role in a pharmaceutical company’s research project when he became president-elect of the heart association, a move required by its top officers.