The pharmaceutical industry does not believe financial relationships between doctors and drug companies compromise clinical-practice recommendations.
"The fact that the authors of some clinical-practice guidelines have also worked for the pharmaceutical industry is a good sign that everybody wants to work with top-flight clinical experts," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, Washington.
His comments were in response to a study released last week showing that almost 90% of doctors who write guidelines for the treatment of common medical conditions have financial ties to pharmaceutical firms, renewing alarm about the influence of the multibillion-dollar drug industry on medical decisions.
About 7% of doctors who took part in the study said they believed their financial relationships with the pharmaceutical industry influenced their recommendations, and about 19% said they thought their co-authors were influenced by financial connections.
The study, the first attempt to gauge the financial ties between drug companies and clinical guideline authors, appeared in last week's Journal of the American Medical Association. It included responses from 100 physicians who helped write 37 of 44 clinical-practice guidelines endorsed by medical societies in North America and Europe. Such guidelines serve as handbooks for physicians on how to treat illnesses and prescribe drugs.
At the least, the study "clearly shows there's a veil of secrecy" in the industry, said Eric Campbell, an instructor at the Institute for Health Policy at Harvard Medical School who researches secrecy in the medical community. "It shows that these (financial relationships) are not discussed and that they are not disclosed."
Fifty-eight percent of the physicians said they had received financial support from drug companies to conduct research, and 38% said they had served as employees or consultants to a drug company. Those physicians had ties with 10.5 drug companies, on average, but the relationships were almost never disclosed in connection with the clinical guidelines, according to the study.
Even the authors of the report-Niteesh Choudhry, M.D., Henry Thomas Stelfox, M.D., and Allan Detsky, M.D., all of the University of Toronto-have connections to the drug industry. Though drug companies did not provide financial support for the study, the researchers said they have at times attended educational sessions sponsored by drug companies. Detsky said he has received consulting fees, research grants and honoraria from pharmaceutical companies.
The study comes at a time when the medical community is struggling with ethical questions and concerns about conflicts of interest in clinical research.
Last September a dozen of the world's most prestigious medical societies unveiled uniform requirements for research studies aimed at ensuring the independence of the authors and researchers.