Financial relationships between health care providers and the pharmaceutical/medical device industry have been shown to influence published treatment recommendations.1 Conflicts of interest are prevalent, and particularly problematic, among authors of clinical practice guidelines,2,3 mainly because these become widely adopted by physicians. The issue is being complicated further by the diminishing government support for research — a hurdle that may steer researchers toward industry dollars.
Now, a new study published in the ASCO Educational Book reveals that National Comprehensive Cancer Network (NCCN) guideline panelists received more money from drug and medical device companies prior to joining the panels than oncologists who did not join the panels.4 Another related study also published in the book points to a link between conflicts of interest and measures of academic success among junior faculty members at top cancer centers.5
The authors of the first study looked at 54 medical oncologists who joined an NCCN guideline panel between August 2013 and December 2018. The researchers matched these physicians in a 1:2 ratio to 108 medical oncologists. These medical oncologists were of the same gender, graduated in the same year, and were from the same institutions as the physicians from the first group but did not join an NCCN panel. The investigators then calculated how much money people in both groups received from drug and medical device companies during the pre-join and post-join period.
The authors found that the panelists had received more industry payments during the pre-join period compared with the non-panelists during the same period ($11,259 vs $3,427, P = .02).
“We found that getting money from industry seemed to be associated with getting chosen to be on one of these panels at a future time,” lead study author Aaron P. Mitchell, MD, MPH, a medical oncologist and health services researcher at Memorial Sloan Kettering Cancer Center in New York City, said in a phone interview.
However, the researchers did not find evidence suggesting that being selected to be on a panel would lead to receiving more industry payments in the 1-year post-join period, specifically.
For the most part, the oncology community appears to have deemed conflicts of interest acceptable, Dr Mitchell explained. According to this same prevailing view, introducing strict restrictions to exclude experts due to their conflicts of interest could ultimately harm the quality of guidelines.
But Dr Mitchell’s study also showed that this perception might be inaccurate, as there were a number of qualified experts in the control group who received zero dollars from industry. “If we made it a priority to increase their representation on the guideline panels, I think we certainly could do so,” he said.