Heart guidelines often show conflict of interest

Most guidelines on treating heart disease are written by doctors with a financial interest in companies that sell heart-related drugs or technologies, according to an analysis published this week in the Archives of Internal Medicine. No wonder some people see those documents not as guidelines but as advertisements.

That's too bad, because treatment guidelines done right can identify what works and what doesn't, and reduce variation in care based on region or economic status. It's possible that the guidelines still offer useful advice. But the conflict of interest—real or otherwise—undermines their value, making it less likely that they'll be adopted by health-care providers and benefit patients.

And it's not just guideline authors who sometimes seem to be working for "the other guy." Medical-school deans, it turns out, often also serve on the Boards of Directors of health-care companies but don't list that relationship on their publicly-available resumes, according to another article in the same issue of the Archives. That's particularly troubling because deans are often held out as the most professional medical leaders and looked up to as model scientists and professionals.

And those are just the latest in a decade of revelations of how the health care-industry influences practitioners. Maybe airing the dirty laundry will finally get professional organizations and medical schools to at least adopt a more neutral stance, for the sake of consumers.

There's some evidence that's starting to happen. The American Medical Student Association is urging medical schools to establish stricter policies about industry relationships. (That's right, the medical students get it and some of their Deans don't.) The American Heart Association and the American College of Cardiology say that new standards require disclosure of conflicts. ProPublica has a public database that lists some 17,000 practitioners who've received money from drug companies and medical device firms. The new health-reform law includes a requirement that drug companies report financial relationships to a national database beginning in 2013. Finally, the Institute of Medicine just released a comprehensive report on "Clinical Guidelines We Can Trust" that includes extensive standards for dealing with the conflict of interest problem. (Full disclosure: I was a member of that Committee).

So what else might be done? Maybe physicians who have financial relationships with industry should tell patients who else they work for. And maybe Deans who sit on industry Boards should walk over to a medical-school classroom, look the students in the eye, explain what they are involved in and apologize for not doing so sooner.

Sources
Conflicts of Interest in Cardiovascular Clinical Practice Guidelines [Archives of Internal Medicine]

Failure by Deans of Academic Medical Centers to Disclose Outside Income [Archives of Internal Medicine]

Dollars for Docs [Propublica]

New Health Law Will Require Industry To Disclose Payments To Physicians [Kaiser Health News]

—John Santa, M.D., M.P.H

—Joel Keehn