http://bmj.com/cgi/content/full/324/7334/383/a
BMJ 2002;324:383 ( 16 February )
News
Authors of guidelines have strong links with drugs industry
Alison Tonks
Most guidelines on clinical practice are written by experts with undisclosed
links to the pharmaceutical industry, researchers from Toronto,
Canada, say in an article in the journal of the American Medical
Association (JAMA 2002;287:612-7[Medline]).
In a survey of nearly 200 authors of 44 clinical guidelines, 87%
of respondents admitted to financial links with one or more pharmaceutical
companies. Over half of the authors had been paid to conduct
research, over a third had been an employee or consultant, and two
thirds had received fees for speaking.
On average each respondent had links with 10 companies, including
companies whose products they recommended in guidelines. Only one of
the 44 guidelines carried a declaration of the authors' competing
interests.
"I'm not at all surprised by these findings," says Dr Bob Goodman,
internist at Columbia University in New York and founder of No Free
Lunch, the campaign for independent prescribing. "Other studies
have already shown extensive links between physicians, researchers,
and even policy makers and the pharmaceutical industry. It's
particularly worrying, though, in the case of practice guidelines. These
documents are widely distributed and intended to change physicians'
practice.
"Any influence of a drug company on an individual author is multiplied
thousands of times. Worse, there's a subjective element to the
recommendations in clinical guidelines that makes them particularly
vulnerable to bias."
Most (93%) of the study's respondents said their relationships with
pharmaceutical companies did not affect their recommendations on
treatment. But evidence cited by the researchers makes it clear that
accepting money from drug companies alters prescribing, drives requests
for additions to hospital formularies, and contributes to
publication bias.
The researchers were unable to check whether authors' financial interests
influenced the treatments recommended in guidelines, because there
were too few independent guidelines in the sample to make a
meaningful comparison.
The study looked at guidelines on the management of 10 common diseases,
including asthma, coronary artery disease, heart failure, depression,
and peptic ulcer. All the guidelines were endorsed by professional
societies in North America or Europe and were published between 1990 and
1999.
The researchers contacted 192 authors, but only 52% responded, despite
a second mailing. They blame the low response rate on authors'
reluctance to admit to links with drug companies and speculate that
those who did not reply had even more to declare than those who did.
If so, the links between authors of guidelines and the drugs
industry are even more widespread than the study indicates, they
conclude.
The researchers want a formal process built in to guideline development that
forces authors to declare their financial interests. They also want
written declarations of competing interests on every guideline.
|
including actors John Hannah and Patsy
Palmer, and Tony Blair's political adviser Alastair Campbell
|
||||||||
|
|
Rapid Response responses to
this article:
Read all Rapid Response
responses
Perceptions of Professional Honesty: What Price?
Beverley Chalmers, et al.
bmj.com, 15 Feb 2002 [Response]
Other related articles in BMJ:
EDITOR'S CHOICE
A modest proposal.
BMJ 2002 324: 0.
ALL INFORMATION, DATA,
AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR
OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING
MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN
IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN
CONSULTATION WITH YOUR HEALTH CARE PROVIDER.