A recent report investigating those who produce clinical practice guidelines has brought to light a shocking prevalence of conflicts of interest among these trusted panel members. Published by the British Medical Journal in October 2011 the report studied the people who make up medical panels that create clinical guidelines in the USA and Canada.

This has been a topic of concern for the medical profession for some time as conflicts of interest between clinicians and the drug industry have become more apparent. A conflict of interest was defined in the study as “direct compensation of a guideline panelist by a manufacturer of a drug...in the form of grants (including research), speakers’ fees, honorariums, consultant/adviser/employee relationships and stock ownership.”

The massive profits made by drug companies over the years have allowed them to become influential in many matters that most people believe should be independent. Their funding of research and sponsoring of stands at exhibitions which generates a large part of the income the academic world survives on, has been a cause of concern.

The study looked at 288 panel members who had participated in developing medical guidelines for the screening and treatment of diabetes and/or hyperlipidaemia. 138 panel members reported conflicts of interest at the time of the guideline publications, 8 were later found to have one or more conflicts of interest although they had formally declared no such conflicts, and a further 12 had financial conflicts of interests. It was found that panel members were more likely to have conflicts of interest in projects sponsored by the private sector than the government sector.

What are Clinical Guidelines?
Medical studies and test results are used by respected doctors to write clinical guidelines that every physician has to follow. The writers of clinical guidelines are known as GOD panelists, which stands for Government Operatives Deliberating.

In the past these guidelines were written simply as suggestions, but now physicians are expected to follow the guidelines in every detail and in every case, or face losing their career or being fined. Unfortunately, this means that decisions are no longer made at the patient’s bedside but by panel members who have now been found in some cases to have a financial conflict of interest.

What the Problem is
Recent revelations have revealed frequent and large “consultancy” payments to physicians; the practise of ghost-writing reports by drug company employees on behalf of physicians and the prevalence of using key opinion leaders. Panelists in these highly sought-after positions of authority have written scientific papers that spin the evidence in order to generate conclusions that will be acceptable to the Central Authority, according to Dr Rich on his healthcare blog. These shocking realizations have led to a lack of confidence in clinical practice guidelines.

Medical guidelines were intended to standardize care and provide evidence-based information to protect patients. In the past, medical guidelines were provided by organizations such as the American Heart Association or the American College of Cardiology. In itself this is not a problem, but in the recent study published in the British Medical Journal it showed that more than half of these committee members were on the payroll of the drug companies. This has been of particular concern in cases where large amounts of money have been riding on the outcome of clinical guideline recommendations.

These “expert panels” of medical specialty boards have been issuing medical guidelines to physicians who have assumed that the information was unbiased. The truth that is now being revealed is that the recommendations were influenced by the drug companies themselves.

Report Conclusion
The report concluded that medical guidelines should be prepared by persons with minimal conflicts of interest to ensure that the guidelines maintained credibility and were based on sound evidence.