Like it or not, there's a seeming inexorable movement in medicine toward guidelines to help the average doctor deliver care that's in line with the latest evidence.
Somebody has to come up with those guidelines. Somebodies, actually, and they usually are experts who sit on panels charged with the task of boiling down the evidence.
But can the recommendations be trusted? A study just out in the BMJ raises new doubts. Researchers found conflicts of interest were prevalent among experts who served on 14 U.S. and Canadian panels that came up with guidelines for the treatment of diabetes and high cholesterol between 2000 and 2010.
All told, 52 percent (or 150 of 288 people) had financial conflicts of interest. Common issues included speaking gigs paid for by industry and consulting deals. Conflicts were more common on the Canadian panels. Government-sponsored panels had fewer conflicts than those other outfits, such as professional societies.
The study authors conclude:
The finding that most current members of guideline panels and half of chairs of panels have [conflicts of interest] is concerning and suggests that a risk of considerable influence of industry on guideline recommendations exist.
An accompanying editorial goes further, saying the financial incentives for companies to skew the work of panels in their favor is a real danger:
With billions of dollars at stake, a company has every motive to encourage potential guideline panelists to view its product in a favourable light, and a virtually limitless budget to support this objective.
Stop the hand wringing and confront reality, Dr. Edwin Gale, a diabetes specialist from England, writes. Legislation can't fix the problem. Instead, he says, the time has come for a fundamental shift in mores: "What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette."