"Clinical practice guidelines play an enormously important role in society and the practice of medicine. Individual physicians use CPGs to determine which diagnostic tests and therapeutic strategies are most appropriate for their patients.
As the above suggests, clinical practice guidelines pretty much dictate what is prescribed and what is paid for in this country, if not the world. It's easy to see how these can play an important role in the profitability of various drugs, devices and other medical products. The above is the beginning paragraph of a commentary recently published in the Archives of Internal Medicine. The commentary was in response to a study, published in the same issue of the Archives, titled "Conflicts of Interest in Cardiovascular Clinical Practice Guidelines."2
The study "examined the 17 most recent American College of Cardiology / American Heart Association guidelines through 2008." Considering the amount of money at stake, the authors' findings should not be much of a surprise, yet they are surely significant:
- Of the 498 individuals involved in the development of these clinical guidelines, 56 percent had some level of admitted conflict of interest.
- Four hundred seventy-eight companies were identified as being involved in the conflicts of interest admitted by the individuals who developed the 17 guidelines.
- An average of 38 companies were identified as involved with conflicts of interest for each guideline, with a high of 242 companies for one guideline.
The implications of this data are obvious. Almost 500 companies "invested" money to potentially influence 279 of the 498 "trusted" individuals who developed the 17 guidelines that will ultimately be used to decide which drugs and devices get prescribed by MDs and paid for by third-party payers. It begs the obvious question: Are these and other guidelines based on sound data or are they merely a reflection of the biases and special interests of those who create them?
The most important part of this study is that it was conducted in the first place. Hats off to Dr. Mendelson, et al., for having the courage to shine their bright light. The other great news is that it did not go unnoticed. An article about this study was published prominently in the March 28, 2011 issue of The Wall Street Journal.3 Similar articles were published in (and/or on the Web sites of) The New York Times, the Boston Globe, TIME magazine, BusinessWeek, the Minneapolis Star Tribune and multiple health care-related publications.
The secret to solving the health care crisis is beginning to be unveiled. It's not about managing care as the public was led to believe 20 years ago. It's about managing greed.
The challenge is not how to lower the cost of health care to include every person. The challenge is to eradicate the profit influence and let the actual data dictate what should be prescribed.
I think (and hope) we can expect more of these studies and articles in the future. The truth eventually comes out, no matter how much money tries to hide it. Perhaps the truth will one day set us all free from the shackles of Big Pharma and allow more American medical patients to become American chiropractic (and alternative health) patients.
- Nissen SE. "Can We Trust Cardiovascular Practice Guidelines?" Comment on "Conflicts of Interest in Cardiovascular Clinical Practice Guidelines." Arch Intern Med, March 28, 2011;171(6):584-5.
- Mendelson TB, Meltzer M, Campbell EG, Caplan AL, Kirkpatrick JN. Conflicts of interest in cardiovascular clinical practice guidelines. Arch Intern Med, March 28, 2011;28;171(6):577-84. www.ncbi.nlm.nih.gov/pubmed/21444849
- Burton TM. "Study Cites Cardiology Conflicts." The Wall Street Journal, March 28, 2011.
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