a coi is a coi…

Posted on Wednesday 30 March 2011

"What’s in a name? That which we call a rose
By any other name would smell as sweet."

Yesterday, there was a flurry of articles about a study that documented the extent of Industry ties of the doctors who wrote the Cardiology Guidelines – good articles every one. I might take some comfort in the fact that the cancer has infected other specialties of medicine besides Psychiatry, but that’s not how it feels. It makes it feel bigger. Can we get to the operating room in time?

Those articles down at the bottom of this post speak for themselves. I just want to highlight one point. "Dr. Steven E. Nissen … called for banning most of those conflicts rather than just disclosing them…" The phrase "conflict of interest" actually means something. It says that the person in question can’t be counted on to be unbiased. Further it means, that the guy in question can’t even count on himself to be unbiased. I’m tired of reading things like, "Just because that company pays me a gajillion dollars a year to give talks touting their drug doesn’t mean that my judgement is impaired when I recommend it."

A "conflict of interest" is a deal-breaker. A "disclosed conflict of interest" is still a "conflict of interest", and so it’s still a deal-breaker [in court, it doesn’t matter if a criminal announced, "this is a stick-up," or "I am a criminal and this is a stick-up"]. I would prefer, "Dr. Steven E. Nissen … called for banning most of those conflicts rather than just disclosing them…"
Can We Trust Our Doctors’ Ties to Industry?
Project on Government Oversight

By Paul Thacker

The stories about doctors on the take from industry never end. Multiple outlets today reported on a study which found that 56 percent of the physicians who wrote clinical guidelines for cardiology had a conflict of interest with industry. Medicine is trying to establish “evidence based” medical care and clinical guidelines set the standards for other physicians to follow. Actually, this result is not surprising. A slew of studies and media reports have found that a majority of doctors have little problem dipping a hand into the corporate cookie jar. What did catch my eye was that 44 percent of the physicians had NO RELATIONSHIP WITH INDUSTRY. Why is this significant? Because it undermines the hackneyed industry talking point that only physicians with industry ties have the scientific competence to make complicated decisions about clinical practice.

Here’s another interesting finding. Almost half the doctors with industry conflicts served as promotional speakers for companies. That means their expertise wasn’t sought by industry to study a disease, improve product design, or safely test a drug on patients. No. These guys and gals were hired as carnival barkers to turn their medical colleagues into product loyalists. In an accompanying editorial, Dr. Steve Nissen of the Cleveland Clinic made clear that there is “no conceivable logic” for allowing promotional speakers to serve in powerful positions that guide medical practice. Until this custom ends, patients and family members should be concerned…

A spokesman for Pfizer told The Wall Street Journal that its ties to doctors were “essential to ensuring that today’s scientific advances truly improve the lives of patients.” If that really was the case…if it really was about patients…if it really ISN’T about padding a bank account…then wouldn’t a doctor donate his/her time to improve patient care as an act of charity? It’s something to think about.
Conflicts of Interest in Cardiovascular Clinical Practice Guidelines
by Todd B. Mendelson, MD, MBE; Michele Meltzer, MD, MBE; Eric G. Campbell, PhD; Arthur L. Caplan, PhD; James N. Kirkpatrick, MD
Arch Intern Med. 2011;171(6):577-584.

Background  Clinical practice guidelines (CPGs) serve as standards of care in practice, quality improvement, and reimbursement. The extent of conflicts of interest (COIs) in cardiology guideline production has not been well studied. Herein, we describe the scope of COIs in CPGs.

Methods  We examined the 17 most recent American College of Cardiology/American Heart Association guidelines through 2008. Using disclosure lists, we cataloged COIs for each participant as receiving a research grant, being on a speaker’s bureau and/or receiving honoraria, owning stock, or being a consultant or member of an advisory board. We also cataloged the companies and institutions reported in each disclosure. "Episode" describes 1 instance of participation in 1 guideline by 1 person. "Individual" describes 1 person who may be involved in multiple episodes. "Company" describes a commercial or industry affiliation reported by an individual in a single episode. Analysis involved descriptive statistics and correlation analyses.

Results  Fifty-six percent of the 498 individuals reported a COI, corresponding to 56% of the 651 episodes. Being a consultant or member of an advisory board was the most common type. The percentage of episodes involving a COI varied between guidelines (range, 13%-87%). The number of episodes per individual was associated with both presence and number of disclosures (P < .001 for both comparisons). Of 478 companies, the number per guideline ranged from 2 to 242 companies (mean, 38 companies). One company was the most frequently reported company in 7 of 17 guidelines.

Conclusion  Conflicts of interest are prevalent in cardiology guidelines, but there seems to be a significant number of experienced experts without COIs.
Study Finds Conflicts Among Panels’ Doctors
New York Times

March 28, 2011

… 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 guy who’s calling balls and strikes should not be a shareholder in one of the teams,” Dr. 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”…

Dr. Kirkpatrick said the study focused on cardiology because of its many guidelines and thorough disclosure requirements. Dr. 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…

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…
    March 31, 2011 | 9:50 AM

    Wait until you’ve seen a 30 year old product manager scream at a KOL for going off message. It cures you of any doubt about what’s going on.

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