Not uncommonly, I use drbriffa.com to draw attention to how conflict of interest might influence health advice. One of the areas that seems quite badly affected in this respect is the recommendations that we get regarding drug therapy. Only last week, I was writing about how it seems we have not been given the full facts about the ‘effectiveness’ of cholesterol-reducing drugs known as statins, and how 8 out of 9 members of a panel that makes recommendations about the use of these drugs turned out to have financial links with companies that make ‘em. You couldn’t script it, I reckon.

Anyway, the New England Journal of Medicine recently took the decision to tackle this issue head-on in the form of an editorial assessing the extent to which the pharmaceutical industry influences official guidelines to doctors regarding appropriate medical care [1].

The author of the article in question, Dr Robert Steinbrook, writes that American clinical guidelines have “…been questioned when pharmaceutical and medical-device companies with a financial stake in the outcome provide substantial funding for their development and implementation.”

He goes on to say that, “At present, the ties between guidelines panels and industry are extensive. A survey of 685 disclosure statements by authors of guidelines concerning medications found that 35% declared a potential conflict of interest.”
This is somewhat shocking, but the situation may be considerably worse. Notice that Dr Steinbrook refers to declared potential conflicts of interest.

By way of example of how such conflicts are not always transparent, consider the fact that the the National Institutes of Health (NIH) in the USA recently cancelled a conference that it had planned on guidelines for screening pregnant women for herpes (a viral infection), after it received a protest letter revealing that four out of five of the planned speakers had undisclosed ties to drug firms that make antiviral drugs.

The risk of guidelines being influenced by the drug industry are smaller in the UK because of the efforts of organisation National Institute of Health and Clinical Excellence (NICE). It is the job of this body to give impartial guidance on which drugs and treatments should be available on the national health service (NHS). Dr Steinbrook recommends a number of strategies that would reduce the influence of industry and special interest groups (which themselves, are often funded by industry), including the setting up of an American version of NICE.

Ominously, the good doctor also warns that whatever system is decided upon “would need independence and financial security: when powerful interests take issue with guidelines, challenges will be inevitable.”

We’ve already seen such a situation come to pass here in the UK: when NICE recently announced that they would not be endorsing the use of drugs used to treat Alzheimer’s disease, two drug companies that make these drugs (Eisai and Pfizer) notified NICE that they would going to court to seek a judicial review of how the decision was arrived at.

It seems to me that there is increasing awareness in the medical profession and in the general public that the pharmaceutical industry has for a long time engaged in the practice of paying for researchers and doctors to feel favourably about their products. This awareness and the willingness of some individuals in the establishment to do something means that drugs companies are finding it increasingly difficult to have things their own way.

This, I believe, is hugely positive. However, in its fight to preserve its bottom line, the pharmaceutical industry is likely to resort to increasingly desperate tactics. Dr Steinbrook’s predictions are, I think, very likely to come to pass. As moves are made for less conflict of interest and more objectivity to determine health care, my sincere hope is that the relevant agencies remain strong and independent in the face of the almost inevitable onslaught.

References:

1. Steinbrook R. Guidance for Guidelines. New England Journal of Medicine 2007;356(4):331-333

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