financial conflict of interest: just one more reason you can’t trust the “evidence” in evidence-based medicine

EVIDENCE-BASED MEDICINE
THE FINANCIAL RELATIONSHIPS BETWEEN THE BIOMEDICAL INDUSTRY
AND THE ORGANIZATIONS THAT PRODUCE CLINICAL GUIDELINES

What have we been led to believe from our youngest years forward?  We’ve had it beat into our collective heads how scientific the practice of medicine is.  But how true is this?   To those in the know, not as much as you would think.  Case in point, Dr. David Eddy. 

Dr. Eddy got his MD the year after I was born (’68), and his pH.D a decade later (Engineering-Economic Systems from Stanford).  For the past five decades his career has read like a veritable Who’s Who in the field of medicine.  He’s written a number of books.  He was Professor of Health Policy and Management at Duke.  He was Director of the World Health Organization’s Collaborating Center for Research in Cancer Policy.  He held top positions on the Board of Mathematics Sciences and their Applications (National Academy of Sciences), as well as the National Committee for Quality Assurance (NCQA).  “Retired” as of 2013 (term used loosely), he continues to work as a consultant and professor.

Although any number of doctors have been credited with starting the “Evidence-Based Medicine” movement (sometimes called “Evidence-Based Practice”, Outcomes-Based Medicine”, or “Best Practices”), it is impossible to argue that David Eddy was not at the forefront. He has likewise been a giant in creating the rules that govern Clinical Practice Guidelines.  Clinical Practice Guidelines are the documents that use peer-reviewed science to guide in the diagnosis, treatment, and management of specific health issues.  It is important to remember that these guidelines are not binding, and physicians / doctor’s groups / clinics / hospitals) must decide whether to follow them or not (HERE is an example).   Take a look at what Dr. Eddy wrote back in the late 1980’s while at Duke….

Only about 15% of medical interventions are supported by, solid scientific evidence….  This is partly because only about 1% of the articles in scientific journals are scientifically sound, and partly because many treatments have never been assessed at all.”

We all want politicians who are not beholding to “Corporate America” (or “Corporate World” for that matter).  Unfortunately what we get today are individuals who are in bed with industry and lobbyists, are jetting around the world giving speeches for half a million dollars a pop, figuring out novel ways to be “legally” (or illegally) bribed, and involved with one scandal after the next.  We’ve come to expect this because we know that politics is a dirty and twisted business.  But the practice of medicine is not like that; is it? 

You would think that medical guidelines would be created by individuals with no ties to industry — after all, Financial Conflict of Interest (FCOA) taints virtually everything it touches.  If you believe this, you think wrong.  I’ve shown you in about 50 different posts filed under “EVIDENCE-BASED MEDICINE” just how bad this problem of FCOA really is within the medical community.  A study released just yesterday verifies this yet again.

Allow me to give you a few tidbits from the medical journal PLoS One’s new study called Financial Relationships between Organizations That Produce Clinical Practice Guidelines and the Biomedical Industry: A Cross-Sectional Study.  Everything will be at least somewhat cherry-picked due to restraints on time and space.  The following two sentences are taken from the very beginning and the very end of the study respectively.

“Financial relationships between organizations that produce clinical practice guidelines and biomedical companies are vulnerable to conflicts of interest.  Financial relationships between organizations that produce clinical practice guidelines and biomedical companies are common and infrequently disclosed in guidelines.”

In 2012, a group of four authors from Alberta, Canada (they were financed by numerous governmental organizations) looked at the guidelines and websites of 95 medical organizations from around the world that created nearly 300 practice guideline documents, which were then published on the National Guideline Clearinghouse website.  Although 100% of the websites were reviewed, less than 2/3 of the organizations creating these guidelines returned the surveys.   After all, who wants to incriminate themselves?  But in the words of Yoda, incriminate they did.  Despite the fact that, “80% of organizations reported having a policy for managing conflicts of interest“……………

  • “63% of organizations producing clinical practice guidelines reported receiving funds from a biomedical company.”
  • “6% disclosed direct funding by biomedical companies.”
  • “40% disclosed financial relationships between committee members and biomedical companies.”

The truth is, I could have gone on and on and on — it’s a fairly large and all-encompassing study (not to mention, the above numbers don’t add up — best guess is that if an investigative journalist got involved, things might really get ugly for the folks on these committees).  But let’s talk for a moment about the brass tacks.  What does it all mean?  Is there Financial Conflict of Interest here?  Are the people creating guidelines cheating both the system and vulnerable patients?  Just look at the author’s conclusions. “Guidelines produced by organizations reporting more comprehensive conflict of interest policies included fewer positive and more negative recommendations regarding patented biomedical products.”  But this is nothing new, as you’ll repeatedly see in the previous link

THE NEW FRONTIER IN GRUBBING FOR CASH
MARKETING DRUGS AND MEDICAL DEVICES TO YOUNG CHILDREN

If you are old enough, you remember the Joe Camel advertising campaign for Camel Cigarettes (1987-1997).  Joe was the cartoon animal world’s version of Dos Equis’ “most interesting man in the world” — always engaged in something fun, exciting, or sexy, and always with a Camel brand cig hanging from the corner of his mouth.  The campaign was wildly effective, with 1 in 3 underage smokers eventually converting to Camels.  Camel’s underage smokers were estimated to account for 6 million in sales in 1988, but nearly 500 million dollars by 1992.  Unfortunately for RJ Reynolds, the gravy train wascoming to an end.

In 1991, the December issue of the Journal of the American Medical Association published a study by five medical doctors concerning using cartoons to advertise cigarettes called Brand Logo Recognition by Children Aged 3 to 6 Years.  Lest you think that this campaign was not specifically targeting young children,

The children demonstrated high rates of logo recognition. The recognition rates of The Disney Channel logo and Old Joe (the cartoon character promoting Camel cigarettes) were highest in their respective product categories. Recognition rates increased with age. Approximately 30% of 3-year-old children correctly matched Old Joe with a picture of a cigarette compared with 91.3% of 6-year-old children. Very young children see, understand, and remember advertising. Given the serious health consequences of smoking, the exposure of children to environmental tobacco advertising may represent an important health risk and should be studied further.”

After being asked by various physicians groups to stop using Joe Camel for advertising CIGARETTES, RJ Reynolds essentially told them to piss off.  Naturally, lawyers got involved, and eventually there was a major lawsuit.  Although this was settled out of court in mid 1997, RJR made a boatload of money in the interim.  I bring this up to show you what’s happening in the world of DRUGS.

Not surprisingly, BIG PHARMA, who has shown a penchant for doing anything and everything to make a buck, has turned to creating “comic books” for grade school children.  Although these comics, complete with super heroes, are handed out free in the name of ‘education,’ Joe Camel proved to us nearly two decades ago that when it comes to advertising to our babies, nothing is free (RJR also happens to be heavily involved / invested in the Pharmaceutical Industry).  I would suggest that you read this sordid story by Rebecca Robbins from today’s issue of STAT (COMIC BOOKS & LESSON PLANS: HOW DRUG COMPANIES TARGET KIDS) in its entirety.  I will warn you to make sure you have a bucket, trash can, or barf bag handy prior to clicking the link!

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