March 30th, 2011

Study Cites Cardiology Conflicts

The Wall Street Journal

Most doctors writing U.S. medical-practice guidelines for cardiology have financial ties to drug and device makers, and many own stock in such companies and give paid speeches for them, according to a study published Monday in Archives of Internal Medicine.

The peer-reviewed study contends such ties create potential conflicts of interest, even though they were disclosed, and could lead to bias.

“Improper bias in the clinical practice guidelines can have a potentially more widespread adverse effect on patient care than individual practitioners’ conflicts of interest,” the study said.

The researchers looked at 17 sets of guidelines issued from 2003 through 2008 by the American Heart Association and American College of Cardiology. These guidelines rank scientific evidence of the safety and effectiveness of various treatments for heart disease, stroke and artery blockage, and recommend certain treatments over others.

For instance, current guidelines say heart defibrillators are “indicated” for patients with limited pumping ability from a previous heart attack and “may be considered” when the limitation has other causes; but defibrillators are “not indicated” for patients unlikely to survive.

Of 34 doctors on a 2008 panel to write guidelines on defibrillators and pacemakers, only seven had no financial connection to a related medical company.

Given the growth of “evidence-based medicine,” such guidelines have become increasingly important. They influence how some doctors and hospitals treat patients, are used in national medical-quality initiatives, and can be cited as the standard of care in medical-malpractice cases. Medicare uses them to help determine which procedures the federal medical-insurance program pays for.

The heart association and the college of cardiology said in a joint statement Monday that panelists with financial ties to industry “could not vote on any recommendation relevant to their relationship.” They also promised to “continue to look closely at our policies regarding relationships with industry.”

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