{"id":41861,"date":"2013-11-25T22:29:21","date_gmt":"2013-11-26T03:29:21","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=41861"},"modified":"2013-11-25T22:29:21","modified_gmt":"2013-11-26T03:29:21","slug":"but-i-shouldve","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/11\/25\/but-i-shouldve\/","title":{"rendered":"but I should&#8217;ve&#8230;"},"content":{"rendered":"<div align=\"justify\">I sort of stepped out of my usual box talking about the Statins [and here I go again]. They are a bit like many of our psychiatric drugs in that they&#8217;re optional, but they differ in that they&#8217;re focused on a measurable biologic marker [serum lipids]. In <a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/11\/24\/an-exempler\/\">an exempler&hellip;<\/a>, I talked about objecting to massive treatment for such a small, if any, health outcome and discussed the risk\/benefit equation. Dr. Poses has a much more detailed review of the issue and adds some sobering dimensions &#8211; primarily in the area of conflict of interest:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/hcrenewal.blogspot.com\/2013\/11\/confused-thinking-about-new-cholesterol.html\" target=\"_blank\">Confused Thinking about New Cholesterol Guidelines &#8211; Were Conflicts of Interest to Blame?<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#0066ff\">Healthcare Renewal<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Dr. Roy Poses<\/div>\n<div align=\"center\" class=\"small\">November 22, 2013<\/div>\n<p>  <\/p>\n<div align=\"justify\">&#8230; One possible reason that the guideline developers got so enthused that  they seemed unable to think straight appears to be their own conflicts  of interest, as first publicly noted in a <a target=\"_blank\" href=\"http:\/\/www.pharmalive.com\/cholesterol-guidelines-panelists-and-their-conflicts-of-interest\">post<\/a> on Pharmalot. Reviewing the disclosure forms provided with the guidelines revealed more detail.<\/div>\n<ul>\n<li>\n<div align=\"justify\">Of the 13 people on the main treatment guideline panel who were not  NHLBI staffers serving ex-officio, 7 had financial relationships with  pharmaceutical companies that manufacture statins&#8230;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Of the 10 expert reviewers for this panel, 3 had financial relationships with pharmaceutical companies that manufacture statins&#8230;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Of the 11 people on the risk prediction panel who were not NHLBI  staffers serving ex-officio, 5 had financial relationships with  pharmaceutical companies that manufacture statins&#8230;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Also, in the Abramson and Redberg NY Times op-ed, the authors noted:<\/div>\n<ol>\n<div align=\"justify\">&#8230;both the American Heart Association and the American College of Cardiology, while nonprofit entities, are <em>heavily supported by drug companies <\/em><\/div>\n<\/ol>\n<ol>  <\/ol>\n<\/li>\n<\/ul>\n<div align=\"justify\">As noted on Pharmalot, the prevalence of conflicted panel members did not appear to conform to the <a target=\"_blank\" href=\"http:\/\/www.iom.edu\/Activities\/Quality\/ClinicPracGuide.aspx\">standards for the development of trustworthy guidelines<\/a> recently published by the Institute of Medicine:<\/div>\n<ul>\n<div align=\"justify\">&#8230;whenever possible, <em>guideline development group members should not have  conflicts of interest<\/em>&hellip; and <em>the chair or co-chairs should not be a  person(s) with conflicts of interest.<\/em><\/div>\n<\/ul>\n<div align=\"justify\">Also, <a target=\"_blank\" href=\"http:\/\/www.latimes.com\/science\/sciencenow\/la-sci-sn-statins-risk-calculator-wrong-20131118,0,3734255.story\">noted<\/a>  by the Los Angeles Times was this comment from Dr John Abramson, lead  author of the commentary on statins in primary prevention,<\/div>\n<ul>\n<div align=\"justify\">&#8216;There is overtreatment that&rsquo;s been built into the risk calculator,  and this is a warning sign about the overtreatment that&rsquo;s built into the  guidelines themselves and the conflicts of interest in the  organizations that are overseeing the production of these guidelines,&#8217;  said Dr. John Abramson, a Harvard University cardiologist who has argued  that statins offer little value for people with a 10-year risk level of  heart attack or stroke of less than 20%. &#8216;There aren&rsquo;t brakes being put  on the enthusiasm and overreaching of the experts.&#8217;<\/p>\n<div>   <\/p>\n<div align=\"justify\">&#8216;<em>There are statin believers, and when you hear these experts talk,  they&rsquo;re talking emotionally, not scientifically,<\/em>&#8216; Abramson added. &#8216;<em>The  experts are using emotion, not science<\/em>&#8216;&#8230;<\/div>\n<\/div>\n<\/div>\n<\/ul>\n<div align=\"justify\"><u><strong><font color=\"#200020\">Summary<\/font><\/strong><\/u><\/div>\n<div align=\"justify\">Guidelines for management of a very common problem promulgated by a  major medical society and a major disease oriented non-profit  organization suggested a strategy that would vastly increase drug  treatment of currently healthy patients.&nbsp; The strategy appears not to  have been based on good evidence.&nbsp; When some of the problems with this  evidence were pointed out, the guideline developers responded with  illogic.&nbsp; Apparently many of the guideline developers have financial  relationships with the drug companies that would most profit from  increases in drug treatment as recommended by the guidelines&nbsp;  Implementation of the new guidelines might results in millions of people  in the US receiving unneeded drugs, with resultant side effects and  costs. .<\/div>\n<p align=\"justify\">  Do we need more examples of how conflicts of interest are causing the  poor outcomes and excess costs that are wrecking our health care  system?&nbsp; Do we need more excuses not to eliminate conflicts of interest  from guideline development?&nbsp; Do we need more delay implementing the  standards provided by the Institute of Medicine report on trustworthy  guidelines?&nbsp; Do we need more excuses not to drastically reduce conflicts  of interest affecting academic medicine, medical societies, and disease  specific non-profits, specifically starting with the earlier [and so  far generally disregarded] Institute of Medicine <a target=\"_blank\" href=\"http:\/\/www.iom.edu\/Reports\/2009\/Conflict-of-Interest-in-Medical-Research-Education-and-Practice.aspx\">report on conflicts of interest in medicine<\/a>?<\/p>\n<div align=\"justify\">  <strong><font color=\"#990000\">While we in the US argue incessantly in the details of minor reforms of  our supposed free health care market, we ignore the rot at its  foundations.&nbsp; True health care reform would attack the conflicts of  interest that have put money, not patients, at the center of health care&#8230;<\/font><\/strong><\/div>\n<\/blockquote>\n<div align=\"justify\">I didn&#8217;t know it was quite that bad [but I should&#8217;ve]. No matter how often it&#8217;s pointed out, I still fall prey to discussing the issue itself when some matter medical bothers me. But by now, I ought to start with conflict of interest, or as  Peter C G&oslash;tzsche labels it &#8211;<em><strong><font color=\"#200020\"> Organized Crime<\/font><\/strong><\/em> [<a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/11\/25\/a-major-force\/\" target=\"_blank\">a major force&hellip;<\/a>]. And speaking of  Peter G&oslash;tzsche, one of the justifications for the new recommendations is a Cochrane Collaboration Meta-analysis update [<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23440795?dopt=Abstract&#038;access_num=23440795&#038;link_type=MED\" target=\"_blank\">Statins for the primary prevention of cardiovascular disease<\/a>]. So do our idols have feet of clay? While that question is open for another day, the level of COI in the guideline authors is enough to invalidate the recommendations pending a review by a non-compromised panel. We&#8217;ve had more than our share of this kind of thing, and rather than debating how much COI is allowed, we&#8217;d best say &quot;None!&quot; At least for now, perhaps forever&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>I sort of stepped out of my usual box talking about the Statins [and here I go again]. They are a bit like many of our psychiatric drugs in that they&#8217;re optional, but they differ in that they&#8217;re focused on a measurable biologic marker [serum lipids]. In an exempler&hellip;, I talked about objecting to massive [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-41861","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/41861","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=41861"}],"version-history":[{"count":7,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/41861\/revisions"}],"predecessor-version":[{"id":41869,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/41861\/revisions\/41869"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=41861"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=41861"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=41861"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}