Conflicts of Interest and Federal Health Guideline Panels
Posted Nov 07 2011 12:00am
Federal health guidelines panels serve an important function. A recent note discussed new guidelines regarding how to monitor older men for prostate cancer (see: When Routine Screening for Disease Has the Potential to Harm a Patient ). However, it now seem likely that it has become increasingly difficult to impanel a group of physician experts that is free of potential bias. A recent article discussed the problem in detail (see: Health Guideline Panels Struggle with Conflicts of Interest ). Below is an excerpt from it:
[T]hree...federal panels that are quietly developing major public health guidelines on the leading causes of cardiovascular disease — hypertension, cholesterol and obesity — operate under less [than] stringent ethics recommendations. And one potential conflict after another has surfaced among the members, with some receiving speakers’ fees from drug companies, others consulting for pay and others doing company-financed research. In all, about 20 of the three panels’ members, including some co-chairmen, have been advised that they should not vote on crucial issues as they prepare to issue the health guidelines next year — because they are too closely connected to industries with a keen interest in the panels’ recommendations. Nearly a decade ago, the work of similar panels was so marred by charges of industry bias that the National Institutes of Health extensively heightened the scrutiny for individual panelists. But the decline in federal financing for medical research continued to pose problems, leaving many researchers to rely more heavily on private industry support. Specific new rules have been adopted to reduce the impact of conflicts of interest on guideline-writing panels. But the N.I.H. groups, which meet behind closed doors, partly to avoid outside influence, had already been appointed when some of those rules were issued. Their finished work could wield a powerful influence on medical care, insurance and lifelong treatment for hypertension, obesity and cholesterol. The National Heart, Lung and Blood Institute of N.I.H., which governs the panels, hired outside contractors to compile and grade the science specifically to avoid bias. Panel members with industry ties are required to disclose them before speaking and to recuse themselves from voting, although N.I.H. officials say there is no penalty if anyone were to defy that self-imposed policy. “You can’t have a panel with expertise in the area that doesn’t have some kind of conflicts,” said [a physician] who oversees the project.
The challenge confronting us regarding federal health guideline panels is clear. Most of the physician experts who sit on such panel are academics who both care for patients and engage in medical research. That's how they become experts in a field. Governmental funding of research projects will continue to decline or stay level at best, the result of which is that such researchers will increasingly turn to industry funding. Such funding, in my opinion, inevitably introduces some degree of bias of the recipients despite claims on the part of some such physicians that they can remain impartial. I am not personally not satisfied by the option of having panel members recuse themselves from voting on recommendations. If members have strong industry ties, they should probably not even sit on these panels because their biases, overt or covert, may sway opinions of others during the discussions of guidelines.
The consequences of all of this are obvious. The panels on hypertension, obesity, and obesity will publish their findings. The media will scrutinize the members of such panels and publicize their sources of industry funding. If these findings are at all controversial, there will be a groundswell of indignation that some of the panel members are biased. This will lead to less weight being assigned to the findings, even if they are very useful from a public health perspective. I am sure that we will muddle with the work of these panels but the net result will be confusion in the minds of healthcare consumers seeking guidance on how to improve their health.
Federal health guidelines panels serve an important function. A recent note discussed new guidelines regarding how to monitor older men for prostate cancer (see: When Routine Screening for Disease Has the Potential to Harm a Patient ). However, it now seem likely that it has become increasingly difficult to impanel a group of physician experts that is free of potential bias. A recent article discussed the problem in detail (see: Health Guideline Panels Struggle with Conflicts of Interest ). Below is an excerpt from it:
[T]hree...federal panels that are quietly developing major public health guidelines on the leading causes of cardiovascular disease — hypertension, cholesterol and obesity — operate under less [than] stringent ethics recommendations. And one potential conflict after another has surfaced among the members, with some receiving speakers’ fees from drug companies, others consulting for pay and others doing company-financed research. In all, about 20 of the three panels’ members, including some co-chairmen, have been advised that they should not vote on crucial issues as they prepare to issue the health guidelines next year — because they are too closely connected to industries with a keen interest in the panels’ recommendations. Nearly a decade ago, the work of similar panels was so marred by charges of industry bias that the National Institutes of Health extensively heightened the scrutiny for individual panelists. But the decline in federal financing for medical research continued to pose problems, leaving many researchers to rely more heavily on private industry support. Specific new rules have been adopted to reduce the impact of conflicts of interest on guideline-writing panels. But the N.I.H. groups, which meet behind closed doors, partly to avoid outside influence, had already been appointed when some of those rules were issued. Their finished work could wield a powerful influence on medical care, insurance and lifelong treatment for hypertension, obesity and cholesterol. The National Heart, Lung and Blood Institute of N.I.H., which governs the panels, hired outside contractors to compile and grade the science specifically to avoid bias. Panel members with industry ties are required to disclose them before speaking and to recuse themselves from voting, although N.I.H. officials say there is no penalty if anyone were to defy that self-imposed policy. “You can’t have a panel with expertise in the area that doesn’t have some kind of conflicts,” said [a physician] who oversees the project.The challenge confronting us regarding federal health guideline panels is clear. Most of the physician experts who sit on such panel are academics who both care for patients and engage in medical research. That's how they become experts in a field. Governmental funding of research projects will continue to decline or stay level at best, the result of which is that such researchers will increasingly turn to industry funding. Such funding, in my opinion, inevitably introduces some degree of bias of the recipients despite claims on the part of some such physicians that they can remain impartial. I am not personally not satisfied by the option of having panel members recuse themselves from voting on recommendations. If members have strong industry ties, they should probably not even sit on these panels because their biases, overt or covert, may sway opinions of others during the discussions of guidelines.
The consequences of all of this are obvious. The panels on hypertension, obesity, and obesity will publish their findings. The media will scrutinize the members of such panels and publicize their sources of industry funding. If these findings are at all controversial, there will be a groundswell of indignation that some of the panel members are biased. This will lead to less weight being assigned to the findings, even if they are very useful from a public health perspective. I am sure that we will muddle with the work of these panels but the net result will be confusion in the minds of healthcare consumers seeking guidance on how to improve their health.