As cancer treatments become both more innovative and costlier, a new study finds that most of the physicians and researchers who help develop treatment guidelines have financial ties to drug and device makers. And the findings are only the latest to raise questions about the extent to which such relationships may ultimately influence decisions for treating patients.
The study found that 108, or 86 percent, of 125 experts who serve on National Comprehensive Cancer Center panels held at least one financial conflict of interest in 2014. About 84 percent of those 125 experts received payments for meals, speaking, consulting and travel, among other things, that averaged $10,000, according to the study that was published Thursday in JAMA Oncology.
Meanwhile, 6 percent had conflicts exceeding thresholds stipulated by NCCN policies, which state that an expert should not have a financial relationship with a value exceeding $20,000 with any one company, and a total of $50,000 with one or more pharmaceutical companies.
The study examined NCCN, which is a nonprofit alliance of 24 US cancer centers, because its panels are influential in issuing treatment guidelines and defining which drugs are reimbursed through Medicare. The authors examined the federal OpenPayments database for industry payments made to NCCN panelists who determined guidelines for breast, colon, prostate, and lung cancer.
“These are the people who are telling other doctors what’s best,” said Dr. Ethan Basch, one of the study authors, who heads the Cancer Outcomes Research program at the University of North Carolina’s Lineberger Comprehensive Cancer Center. “We’re not saying there is bias, but there’s a potential for bias and the appearance of bias, which is concerning … So we recommend that panelists not have relationships with industry beyond research payments.”
The authors suggest an exception for research payments for a few reasons. Notably, because most research funding comes from industry, accepting research funding may be necessary for many academics and researchers. And the authors also posit that “there may be societal value” in having physicians who bridge the space between academia and industry so they can further ideas into clinical research.
The study noted that not all academic oncologists had financial conflicts with industry as a result of research work — 39 percent accepted payments for consulting, speaking or other activities, but not for conducting research. Overall, NCCN panelists received research payment that averaged more than $236,000 from industry, the study found.
This is only the latest study, however, to raise concerns about the extent to which individual experts and their ties to drug makers may influence crucial treatment guidelines. As we noted recently, the issue was widely debated three years ago when new guidelines were issued for prescribing statins to treat high cholesterol.
A study published last week found that many experts who assemble treatment guidelines for Canadian medical societies hold conflicts. A 2009 study found 90 percent of authors of guidelines for treating schizophrenia and depression held conflicts with drug makers, but did not disclose their ties. And a 2011 study of cardiovascular treatment guidelines found more than half of the authors reported a conflict.
As for the NCCN, Dr. Robert Carlson, who heads the organization, told us that “we take very seriously the integrity of our guidelines program, including issues surrounding conflicts. And we have a number of processes, procedures, and safeguards in place. For instance, we collect conflict information on panelists every six months.”
He added that the study authors presented some of their findings at a recent cancer meeting, which prompted NCCN to review its program and found that less than 1 percent of the panelists reported any financial conflicts exceeding NCCN thresholds. He also maintained that relying strictly on OpenPayments may be problematic because some doctors continue to dispute the figures reported by companies.
Carlson also maintained that choosing only experts without conflicts would be counterproductive. “If you look at individuals with the depth of expertise to help devise guidelines, they’re going to be people the pharmaceutical industry wants input from. And it’s a relatively small group of people whom you want to be involved in all facets of activities. I think eliminating financial conflicts would end up with panels that are relatively unbalanced and not as expert as you’d like them to be.”
The average community based hospital oncologists are so swamped with an aging cancer population they barely have time to read the literature. On the other hand the academics generally don’t see patients in large numbers and hence have the time to read and do the research in order to develop a unique expertise in a very specific area. I wouldn’t want the doc who is seeing patients from dawn to dusk and has a six month backlog of journal reading to be the one writing the guidelines, which is a shorthand version of saying why drug companies rely on academics to develop guidelines and compensate them for their efforts.
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