Conflict-Free Panels Are Possible & Necessary

Duff Wilson of the New York Times this morning puts the spotlight on three National Institutes of Health panels deliberating new clinical practice guidelines for managing cholesterol, hypertension and obesity and finds significant conflicts of interest among the panel members. No surprise there. Most guideline-writing committees in most specialties across the medical profession are laced with physicians on the payrolls of companies with a financial stake in the final product of the committees’ deliberations.

Duff Wilson of the New York Times this morning puts the spotlight on three National Institutes of Health panels deliberating new clinical practice guidelines for managing cholesterol, hypertension and obesity and finds significant conflicts of interest among the panel members. No surprise there. Most guideline-writing committees in most specialties across the medical profession are laced with physicians on the payrolls of companies with a financial stake in the final product of the committees’ deliberations. Just put the phrase “conflicts of interest” in the search engine on this website, and you’ll see more than 200 articles I’ve written in the past few years documenting and lamenting this phenomenon.

What also isn’t new is the defense of the practice, which was articulated in the Wilson article by the National Heart Lung and Blood Institute’s Denise Simons-Morton. “You can’t have a panel with expertise in the area that doesn’t have some kind of conflicts,” she said.

That is simply not true. When the Food and Drug Administration commissioned a study to see if it couldn’t make up its advisory panels with conflict-free experts, the outside consulting firm discovered that it would take about one week to find unconflicted physicians with the skills required to analyze clinical trial and other data needed to serve. Moreover, based on the publication records of the people turned up by such a process, the unconflicted physicians would have been more highly qualified than the “thought leaders” on drug or other industry payrolls who actually got the jobs.

The presumption that people with ties to industry have greater expertise was best summed up during Tevye’s song in Fiddler on the Roof, “If I Were A Rich Man”:

The most important men in town would come to fawn on me!
They would ask me to advise them,
Like a Solomon the Wise.
“If you please, Reb Tevye…”
“Pardon me, Reb Tevye…”
Posing problems that would cross a rabbi’s eyes!

And it won’t make one bit of difference if I answer right or wrong.
When you’re rich, they think you really know!