Financial conflicts of interest in guidelines

A new study published in the BMJ shows the prevalence of financial conflicts of interest in the panel members producing clinical guidelines. For consumers of healthcare delivery (that means everyone), I think it is valuable to know that doctors get their information from guidelines, and about half of the people developing those guidelines have financially-based conflicts of interest (e.g. they get money from pharmaceutical companies). The fact that this is not a surprise is probably the most worrying issue.

This is the second time that we’ve heard that journals have become “an extension of the marketing arm of pharmaceutical companies”.

Unfortunately, the double-edged sword is that many talented people do excellent work, and get money from pharmaceutical companies. Removing financial conflicts of interest would remove their talent from the construction of evidence and guidelines. 

Australians’ views of our own health system

In a data briefing published in the last couple of days in the BMJ, there was an interesting graphic that indicated the public perception of the healthcare system. Although it isn’t particularly easy to find the source of the information in the Health Affairs cited by Appelby (an article with open access), the results are particularly striking for Australia.

While over 60% of the public in the UK believe that only minor changes are needed, around 75% of Australians believe that our health system needs fundamental changes or a complete rebuild. This perception is even more negative than the US, for which the system is widely known to be overly expensive and suffering from huge gaps in access for the disadvantaged.

A big, important step in (public) health (economics)

The NY Times reports that four large health insurers have agreed to release claims data to academics on a regular basis. Claims data will allow us (researchers) to look in much greater detail at what is driving excess costs but much more importantly, to find out how quickly physicians are taking up new (and hopefully better) practices, and perhaps even pinpointing where/when/why sub-optimal practices are occurring and take steps to mitigate.

We have been playing with claims data in some recent (Australian-based) work as well as during the Heritage Prize – it’s typically messy but not impossible to work with. Let’s also hope the definition of “academic” does not equate to “US-based academics”.

Measuring only skin deep conflicts of interest won’t help

Conflicts of Interest in Cardiovascular Clinical Practice Guidelines

In the most recent issue of Archives, a group of US researchers have analysed the cardiovascular clinical practice guidelines on which clinicians rely to make informed decisions about how best to treat patients. Conflicts of interest are contentious in this area because they are known to influence how evidence is reported in a number of interesting ways.

The authors find that conflicts of interest were not as large a problem as many might imagine them to be. My argument here is that 56% of the authors of the clinical practice guidelines may be supported partially (or more) by pharmaceutical companies but they are still writing guidelines based on evidence that may be more dependent on big pharma, from clinical trials that may be funded and designed by big pharma, and with the concerted effort of a 900 billion dollar industry helping them reinforce the need for more pills.