http://www.reutershealth.com/archive/2002/02/05/eline/links/20020205elin006.html

Most doctors who set guidelines have industry ties

By Jacqueline Stenson

NEW YORK, Feb 05 (Reuters Health) - 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, a new study concludes.

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, according to the report in the February 6th issue of The Journal of the American Medical Association.

"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," study author Dr. Allan Detsky, physician-in-chief at Mount Sinai Hospital in Toronto, told Reuters Health.

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," Detsky said.

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.

Detsky pointed out that 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. Detsky himself has received honoraria for speeches, consulting fees and research grant money from drug companies.

So how much industry involvement should disqualify a doctor from participation in clinical guidelines? "That's the $64,000 question," Detsky said. "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 we can preclude these conflicts from harming the consumer," Detsky said.

In the survey, 55% of respondents said the guidelines they worked on had no formal process for declaring relationships with drug companies. And just 2 of the 44 guidelines evaluated in the study listed the authors' industry relationships in print.

SOURCE: The Journal of the American Medical Association 2002;287:612-617.

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