How Does the Medical Industry Influence Patient Care?

May 20, 2011

20 May | ProPublica - As we reported earlier this month, there are often deep financial ties [1] between professional medical societies and the drug and medical device industries. This week, other news outlets chimed in, detailing how recommendations made by two medical societies raise at least the appearance of a conflict of interest.

by Nicholas Kusnetz
ProPublica

Professional groups represent physicians in specialized areas of medicine. They are responsible for writing the guidelines that those physicians use to decide on treatments and care. The organizations also lobby for the interests of their members. But recent [2] reports [3] question whether some of the groups’

The National Lipid Association, for example, has been working on recommendations for the screening and treatment of a group of genetic disorders that can lead to premature coronary artery disease. It turns out the development of those recommendations was supported by $112,500 in grants [4] from six drug companies that stand to profit from the results, according to the website Cardiobrief [2]. Many societies explicitly ban such funding for guideline writing because of the appearance of conflict.

The association told Cardiobrief that the grants were among various sources of funding for the development of the guidelines, but it did not specify what percentage of the funds came from drug companies. The Lipid Association hasn’t responded to our request for comment, but it gave the following response to Cardiobrief (the genetic disorder is known as familial hypercholesterolemia, or FH):

“The [National Lipid Association] maintained full control over the planning, content, quality, scientific integrity, implementation, and evaluation of the FH conference and resulting recommendations, as well as the FH public education campaign. All related activities are free from commercial influence and bias.”

The guidelines recommend increased screening [2] of children as young as 2, which one expert said [2] would be excessive. One of the companies that sponsored the guidelines — and that has a drug in the pipeline for the condition — has been quick to promote the association’s new recommendations. Aegerion Pharmaceuticals obtained early copies, apparently as a result of a publishing mistake, and sent them to physicians [2] with an accompanying message, saying, “These publications illustrate the need for wide-spread screening and early diagnosis and treatment of FH.”

In another recent case, reported by BNET [2], the U.K.’s Royal National Institute of Blind People came out against the use of a cheap alternative for treating a type of macular degeneration. The institute, as it happens, has long received support [5] from Novartis, the U.K. marketer of Lucentis, which is 40 times more expensive [6] than an alternative drug. Researchers at the National Institutes of Health recently found [7] that a much-cheaper drug, the cancer treatment Avastin, is just as effective, though it is not formally approved for treating macular degeneration. (In the United States, both Lucentis and Avastin are marketed by Genentech.)

But the Royal Institute criticized the British government [6] for encouraging the use of the cheaper Avastin, saying, “Safety should not be compromised by cost.” In written comments to ProPublica, the organization elaborated on its position, saying, “There is still insufficient data to draw firm conclusions on the comparative safety of these drugs.”

BNET details a number of financial ties [8] between Novartis and the institute, including a recent grant [9] worth more than $500,000. The institute pointed out that the grant, which Novartis issued this year, is a tiny percentage of the organization’s funding, representing about 1 percent of all donations [10] received last year.

“We have relationships with a number of companies whilst always maintaining our independence,” an institute spokeswoman said via email.

Novartis told us it works with many organizations to support education and raising awareness for different medical conditions and that all financial support they provide is compliant with industry guidelines. The money does not buy influence, the company said.

“How patient groups choose to spend funding provided by Novartis is entirely their decision,” the company wrote in an email.

As we reported earlier this month, financial links between these professional societies and the drug and device industries are a widespread concern [1]. The Heart Rhythm Society got nearly half [11] of its $16 million in donations last year from companies that make drugs and devices used to control abnormal heart rhythms. The Society for Cardiac Angiography and Interventions took in $4.7 million, more than half of its total receipts in 2009, from drug and device manufacturers [12].

As we put it then [1]:

Professional groups such as the Heart Rhythm Society are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.

The groups say the industry money helps them provide better education and that their members develop better treatments. They say they have guidelines to ensure the money doesn’t buy influence.

But as our nifty interactive graphic [13] shows, it does buy — or at least get your name on — just about everything else, including tens of thousands of dollars for coffee cup sleeves [14] at the annual conference, $15,000 for goodie bags [15], or as much as $70,000 to get your name on hotel key cards [16].

We also reported that Heart Rhythm Society tip sheets tout the effectiveness [17] of some medical devices without mentioning dangerous side-effects. The sheets are posted on the society’s website and are meant to help patients research options for treatment. But the sheet for one defibrillator, for example, says the device is 99 percent effective while failing to mention that it can deliver unnecessary and painful jolts. The makers of these devices are among the society’s biggest funders [11].

As the Cleveland Clinic’s Dr. Steven Nissen told us, “What you’re exploring here is the subtle ways in which the companies and professional societies become partners and — wittingly or unwittingly — physicians become agents on behalf of the interests of the sponsoring company.”

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