Media's reports on statin guidelines leave financial ties undisclosed

There's good reason for the confusion among physicians and patients over the latest guidelines on managing cholesterol to reduce heart disease risk, which were issued this week by the American College of Cardiology, the American Heart Association and other organizations. The media coverage has been all over the map, with few guideposts to sort out the conflicting claims by the experts quoted in the stories.

The initial news reports suggested the guidelines would result in a sharp cutback in statin use to lower cholesterol since doctors were being told to ignore targeting a particular cholesterol level. “We deliberated for several years and could not come up with solid evidence for targets,” Dr. Neil Stone, professor of preventive cardiology at Northwestern University's Feinberg School of Medicine in Chicago and chairman of the committee responsible for the new cholesterol-management guidelines, told the New York Times.

Yet an op-ed in Thursday's Times co-authored by Dr. Rita Redberg, the editor of JAMA Internal Medicine, suggested the recommendations would result in a major expansion in the number of people taking statins. The article claimed the expanded use would probably do more harm than good.

At times like these, it's important for doctors and patients to know whether people making competing claims in the media have financial ties to manufacturers of the therapy in question, in this case, drug manufacturers. From a strictly financial point of view, no one has more to win or lose from how the new guidelines are interpreted than statin makers.

Readers never got that information from the media coverage. Not a single physician quoted in the Times' stories, for instance, had their conflicts of interest mentioned, which is standard operating procedure in leading medical journals. Nor did the media coverage reveal the conflicts for the guideline writers themselves.

While Stone had no consulting, speaking, ownership, personal research or expert witness payments to disclose, the co-chair of the ACC committee, Dr. Jennifer Robinson, a professor in the department of epidemiology at the University of Iowa's Carver College of Medicine, disclosed she has conducted personal research this year for several drug companies. One of them was AstraZeneca, maker of best-selling Crestor, which is still on patent.

The Times in its initial coverage extensively quoted Dr. Daniel Rader, director of the University of Pennsylvania Health System's preventive cardiovascular medicine program. He suggested physicians would ignore the guidelines and continue prescribing statins to achieve low cholesterol targets.

What journalist Gina Kolata failed to tell Times readers was Rader's relationship with Novartis, Eli Lilly, Pfizer, Merck and Aegerion Pharmaceuticals—or how, as a member of the Speakers' Bureau, he has received honoraria (PDF) from Abbott Laboratories, AstraZeneca, GlaxoSmithKline and Johnson & Johnson. Even frequently quoted skeptics such as Dr. Harlan Krumholz of Yale University and Dr. Steven Nissen of the Cleveland Clinic have ties to companies, yet none were revealed in the press.

Medical journal editors spent years debating whether to disclose conflicts of interest when publishing studies and guidelines and eventually came down on the side of full disclosure. Journalists followed suit when the Association of Health Care Journalists urged reporters to “be vigilant in selecting sources” and to report links between experts and private companies.

This was a week when it would have been helpful if journalists had paid attention to their own guidelines.

Follow Andis Robeznieks on Twitter: @MHARobeznieks