Undisclosed Financial Conflicts Endemic in Clinical Practice Guidelines

Justin Karter
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While there has been a recent push to account for financial conflicts of interest in medical research, less attention has been paid to organizations that produce clinical practice guidelines (CPGs) that offer official treatment recommendations to doctors and providers. A new analysis published this week in the journal PLOS Medicine reveals that such organizations are often rife with financial conflicts of interest with biomedical companies and that these conflicts are often undisclosed. According to the study, only one-percent of the guidelines disclosed the organization’s financial relationships with companies and only half of all guidelines disclosed the financial conflicts held by individual members of the organizations.

“These types of relationships can have undue influence because clinical practice guidelines are resource intensive to produce and are developed by a small number of expert clinicians who determine the scope of the guidelines, synthesize and interpret the published evidence base, and provide recommendations,” the researchers, Henry Stelfox and his colleagues from the University of Calgary in Canada, write.

“The potential impacts of conflicts of interest are large because clinical practice guidelines are designed to be widely disseminated and influence the practice patterns of large numbers of healthcare providers.”

Doctors and health care professionals often rely on clinical practice guidelines when making treatment decisions.

Clinical Practice Guidelines (CPGs) are at the heart of “evidence-based medicine.” While research outcomes may vary across studies, CPGs are intended to critically review all of the existing research on a topic and offer doctors and practitioners best-practices to follow. In theory, medical organizations that create CPGs will take a serious look at the strengths and weaknesses of existing research on a topic, acknowledge deficiencies, shortcomings and potential biases in the studies, and, in doing so, provide a check for scientific integrity. For more on the performance of CPGs in psychiatry see “Psychiatry Under the Influence,” by MIA founder Robert Whitaker and psychologist Lisa Cosgrove.

To determine whether or not the organizations that produce CPGs are disclosing financial conflicts of interest among their members, the organization itself, and biomedical companies, researchers reviewed 290 CPGs from 95 national and international medical organizations. They found that biomedical companies had directly funded 63% of these organizations but that only four of these groups, about 1%, declared these relationships as conflicts of interest.

In addition, only 51% of the organizations disclosed the financial conflict of interests of their individual committee members, the people responsible for writing the guidelines. Amazingly, when surveyed 80 percent of all of the guideline issuing organizations reported having a conflict of interest policy in place, yet they often failed to follow their own stated policies. For example, forty-one groups stated that they require a majority of all committee members to be free from conflicts, but 25 of these (61%) had issued at least one guideline where a majority of the members did have such a conflict.

“The perception of conflicts can call the reliability of a recommendation into question, and even more so if there was no disclosure. This new study adds fuel to those concerns,” Hilda Bastian writes in a review of the study.

“Stelfox and colleagues found that organizations with weaker policies on financial conflicts tended to make more positive recommendations about the use of biomedical products.”

 

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Paul Campsall, Kate Colizza, Sharon Straus, Henry T. Stelfox.Financial Relationships between Organizations That Produce Clinical Practice Guidelines and the Biomedical Industry: A Cross-Sectional Study. PLOS Medicine, 2016; 13 (5). (Full Text)

11 COMMENTS

  1. This courageous and invaluable analysis of the marketing collaboration between drug manufacturers and those (allegedly) academic medical professionals with enormous influence on the prescribing decisions of doctors, is of fundamental importance in medical ethics.
    Is any patient in a position to provide valid, informed consent for an advised prescription medication program without their doctor advising whether or not they are receiving financial advantage from the manufacturer of the drugs which they advocate?
    What is surely needed is a “Conflict of Interest Patient Reference Website” –
    (A concept previously advocated By Professor Peter C. Gotzsche in his outstanding analysis: – “Dangerous Psychiatry and Organised Denial” -2015.)
    This must identify all pharmaceutical companies from whom money has been accepted, detail of amounts paid, when and by whom. This information should be available to every patient and their partner/family where appropriate.
    It would be recommended that such information should be considered in great detail before presenting any prescription for dispensing.
    Those doctors who, have no such conflicts of interest, will immediately and justifiably have patients trust in the integrity of their prescribing enhanced.
    Better still perhaps, every physician who considers that it is ethical and acceptable practice to receive pharmaceutical company payments should have every conflict of interest watermarked into each individual sheet of every prescription pad they use.
    Patients about to expose themselves to potential adverse drug reactions would then be able to ask themselves the pivotal question of medical integrity: –
    Who in fact is this individual doctor’s primary priority, their payer or their patient?

    • Interesting point, “Who in fact is this individual doctor’s primary priority, their payer or their patient?” Especially given the reality that the patient is paying through the nose for their health insurance, thus feels they are personally paying their doctor, since tons of money is being taken out of their pay check for supposedly proper health care. And, isn’t it ironic that whom you, as a doctor, claim is the payor, the pharmaceutical companies, is also advertising all over the mainstream media that the patients should “ask your doctors,” implying heavily they should trust their doctors.

      The bottom line reality is I did not realize, in regards to my doctors, that someone other than I, may have been paying my doctors. Especially since some of my doctors were paid out of pocket, rather than through my health insurance, thus I was, in fact, personally paying my doctors. And it never occurred to me that the pharmaceutical companies were paying my doctors to encourage them to coerce and force drugs down my throat, because this is blatantly unethical behavior.

      The reality is the whole system is set up to the detriment of the patients, and to the benefit of the medical, insurance and pharmaceutical corporations / industries. We need a health care system set up in a manner that will benefit the patients, not the corporations / industries and their stockholders only.

      http://www.dailymail.co.uk/health/article-3460321/How-Big-Pharma-greed-killing-tens-thousands-world-Patients-medicated-given-profitable-drugs-little-proven-benefits-leading-doctors-warn.html

      Glad some of the doctors are waking up to the problems, Drtim.

  2. DANGEROUS PSYCHIATRY.

    http://ps.psychiatryonline.org/doi/abs/10.1176/ps.49.10.1361-b#/doi/abs/10.1176/ps.49.10.1361-b

    From The Link:
    “…However, an economic analysis that compared depot antipsychotic treatment with a traditional oral neuroleptic and an atypical medication (risperidone) concluded that switching to depot medication for outpatient therapy could result in lower treatment costs …”

    They are wrong about economic benefits. These drugs create longterm psychiatric dependency in people that would otherwise recover – with basic psychotherapy; and the death rate on these drugs is high.

    http://www.nuigalway.ie/our-research/partners/

    • Fiachra, – I share your concern that in addition to the appalling injuries and early death caused by “antipsychotics” (which in effect refers to “second generation antipsychotics”) a true broadly based, extended financial analysis of the all embracing economic cost of prescribing these grotesquely toxic drugs for months, years and lifetimes must identify a massive, avoidable financial burden on health care provision.

      In the U.K. this week –
      “New guidance from NHS England and the Royal College of General Practitioners encouraged
      GPs to review prescriptions for patients with learning disabilities or autism” –
      They are –

      “Urged to to cut the number of inappropriate prescriptions of psychotropic dugs ” –

      Surely that would provide a work load lasting their lifetime wouldn’t it?
      It is recognised however, that in many or most circumstances the initial prescribing would originate in psychiatry and not primary care.
      Antipsychotic tapered withdrawal is encouraged but I fear that GPs will not find it easy to deal with new antipsychotic induced injuries and toxicities which appear both during taper and after cessation. I have witnessed psychiatrists explaining such adverse drug reactions, including withdrawal induced akathisia, as an absolute demonstration that the patient
      “clearly needs the antipsychotic”.
      In some cases, the prolonged, extremely slow recovery from antipsychotic induced brain injury would be expected to leave the patient vulnerable to social isolation and profound loneliness in addition to recurrent nightmares and severe extended post traumatic distress (NOT DISORDER). This is in whole or in part caused by the returning memory increasing clarity of recollection and awareness of their incarceration and the institutional brutality they have experienced. This may have followed a psychiatric presentation originally, or a misdiagnosis, for example SSRI or other psychotropic medication induced akathisia, especially if they have a genomic CYP 450 variant metabolic vulnerability to delayed metabolism /detoxification.
      I have gained greater insight into these toxicities from Professor Gotzsche’s book and the extensive references provided.
      It causes me genuine concern that I misquoted the title which is:-
      DEADLY PSYCHIATRY and ORGANISED DENIAL. Peter C. Gotzche. 2015.
      Apologies to M.I.A. for my error.
      There is a BMJ on-line reference for the “inappropriate prescriptions of psychotropic drugs – -”

      BMJ 2016; 353; i3137.

      Tim.

      • Thanks Drtim,

        You know what you’re talking about.

        On the subject of inappropriate prescribing an Autistic person can have great difficulty expressing their toxic reactions – and get MISDIAGNOSED for “acting out”.

        I acted out (suicidally) a number of times.

        The nurse told me that I was lucky that the (Irish) Psychiatric system was prepared to accept that “drug induced restlessness” actually existed. They did accept this verbally – BUT they did NOT enter it in my notes.

    • There are several reasons why a lot of people don’t know how corrupt the current mental health industry is.

      Psychiatry and Big-Harma both seek to maintain the status quo of power, profit, and control. They control the narrative. And they have the money to buy time in the media (adverts, news stories, etc). Since a lot of people just switch on the TV and don’t look at alternative information sources, all they get is what the TV (and by extension, Big-Harma and psychiatry) tells them. So part of the problem is so many people are so braindead or brainwashed that they don’t think for themselves or question what the tel-lie-vision tells them. And the mainstream media isn’t going to tell people how corrupt the (mental) health industry is because the industry pays the media so much in advertising money, and the media won’t bite the hand that feeds them. So, people need to start thinking for themselves and stop believing everything the TV/establishment tells them.

      But hey, it’s not just psychiatry and Big-Harma that are corrupt, it’s the entire system, including government, media, biotech, law, health, defence, etc. Good people don’t rule the world. Evil people do. And it’s amazing that so many people are to blind/stupid to see it.

  3. Reflecting on these posts a couple of months on, I am increasingly asking myself:- how could I possibly have been so naive as to trust and respect the current drug driven and merciless false paradigm of biological psychiatry?
    During four decades of medical practice I met, collaborated with and grew to respect many gifted and devoted doctors in a range of disciplines. Their raison d’être was to strive for the best possible clinical and personal outcomes for their patient’s physical (primary objective) and always (albeit the secondary objective) personal, psychological and social outcomes.
    This often came at significant cost to these doctors families, as well as to themselves..
    Like so many – I would go for many years without holidays being interrupted, even dominated by requests from patients in genuine need or from their carers or physicians.
    This was perceived to be the norm.
    Such respect turned out to be dangerous, damaging and destructive when transferred, without insight, into the realities of the pharma-marketing dominated and science-fiction evidence based hubris of psychiatry.

    With regard to the dangers of prescribing, In the UK our regulators have advised, us: –

    “YOU MUST PROTECT PATIENTS FROM THE RISKS OF HARM POSED BY COLLEAGUES PRESCRIBING, ADMINISTRATION AND OTHER MEDICINES RELATED ERRORS.”

    This is clearly intended to apply to individual practitioners on a case by case basis.
    The vast suffering, injury and destruction caused by institutionalised prescribing errors in the cult-like, drug, detain and enforce modus operandi of mainstream psychiatry overwhelms this fundamental professional duty.
    My professional respect for those who have found the integrity, honesty and courage to speak out from within this immensely powerful and ruthless “medical speciality” continues to grow incrementally.

    Dr. Tim.