Thursday, August 28, 2008

Conflict of Interest

The U.S. National Cholesterol Education Program (NCEP) is a government organization that educates physicians and the general public about the "dangers" of elevated cholesterol. They have a panel that creates official guidelines for the reduction of cardiovascular disease risk. They contain target cholesterol levels, and the usual recommendations to eat less saturated fat and cholesterol, and lose weight.

They recommend keeping LDL below 100 mg/dL, which would place tens of millions of Americans on statins.

I was reading Dr. John Briffa's blog today and he linked to a government web page disclosing NCEP panel members' conflicts of interest. It's fairly common in academic circles to require conflict of interest statements, so a skeptical audience can decide whether or not they think someone is biased. The 9-member NECP panel was happy to indulge us:

Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline.

Dr. Cleeman has no financial relationships to disclose.

Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.

Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.

Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer.

Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer.

Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.

Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson.

Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.

Every company in bold is a statin manufacturer. This is outrageous! These are the people setting official government blood cholesterol target values for the entire country! Eight out of nine of them should be dismissed immediately, and replaced by people who can do a better job of pretending to be impartial!

11 comments:

Methuselah said...

Stephan,

Outrageous indeed. I think the reason they get away with this is that the low cholesterol mantra remains, in the minds of most people, a 'no-brainer'. People only question motives when they can see a possibility that the advice has the potential to be distorted - if they think it does not then it does not seem important that there could be a conflict of interest and they focus their attention elsewhere. I think it's up to us (by which I mean the enlightened, vocal public) to make as much noise as possible. So it's good to see you and Dr Biffa posting on this and it's something I may raise on my blog myself in due course - I am focusing on the crimes of health food retailers at the moment ;-)

Stephan said...

Methuselah,

That makes sense. Still, from an academic standpoint, a respectable journal probably wouldn't touch a paper on LDL reduction written by those 9 authors.

I think it's a sign that the US government is packed with industry shills. It's really depressing considering the magnitude of their influence. They don't just influence the US, but all the other countries that look to us for the latest medical advice.

We could be talking about hundreds of millions of people who are unwittingly being exposed to a statin commercial, courtesy of the US government.

I actually don't have a problem with industry funding research under certain circumstances. But some of these panel members have been paid by drug companies for "educational presentations" and consulting work. That is too close for comfort.

By the way, I checked out your blog, looks interesting.

reid said...

There definitely needs to be some sort of oversight to prevent this from happening. It's just another aspect of a larger pattern of government appointees and commitee members having corporate ties. Conflicts of interest are also commonly found in the EPA, FDA, USDA, FCC, National Commission on Energy Policy, not to mention the oil and pharmaceutical connections of many in the current administration.
In his latest book "The Wrecking Crew" Thomas Frank describes the "revolving door" relationship of politician, lobbyists and industry.

Stephan said...

Reid,

I'll have to read that.

Debs said...

Yet another institution tainted by corporate interests. Always disheartening, even if unsurprising. It's especially outrageous in cases like this where people's health and wellbeing come second to corporate ties.

David Korten's also written about this stuff.

Debs
Food Is Love

Stephanie said...

Yes, I also found it curious when just following Pfizer's big marketing push for Lipitor, the national standards for acceptable cholesterol levels suddenly went down - everyone who used to have an acceptable level of LDL at 130, was now at risk and was subsequently put on statin drugs for prevention. I sent a letter to the New York Times in 2005 stating my skepticism and predicting some oversight, but I guess it never happened.

Stephan said...

Stephanie,

Thanks for taking action.

LucienNicholson said...

They might have conflict of interest problems, but attack their science, not their financial holdings. While they might have a conflict of interest, it is in the open and it has no bearing on the validity of their science, which is much more easily assailable.

I agree that it is a fine line they walk. Is there a better source to get funding than from the government or drug companies?

Stephan said...

Hi Lucien,

I do attack their science, all the time. The problem is deeper than financial holdings. Some of these people are paid speakers for statin manufacturers. They're one step away from appearing on TV commercials for lipitor.

I'm not against industry funding; you have to get research money from somewhere. Rigorous peer review is there to try to weed out bias. But these people are far too entangled with industry to be impartial.

Even if they were impartial, no informed person is going to listen to them because of their industry connections. If you want to be taken seriously, you can't have such gross conflicts of interest.

The Stark Raving Viking said...

Excellent post, this is how government and corporations are ruing the country.

Ruth Almon said...

The sad thing is that there's nothing surprising here. Business as usual.