Editor—Ferner and McDowell highlight the direct marketing of product messages via the media.1 This is important, but it is obvious, unsophisticated, and has begun to attract condemnation.2
“Specialist societies” and “disease interest groups” have an important role. These are often dependent on pharmaceutical sponsorship, and their leadership is heavily targeted by the marketing arm of the drugs industry. The grey market of “satellite symposia” and ad hoc promotional meetings provides fertile ground where self interest, disease promotion, and marketing combine. Opinion leaders can be provided with soft research grants, included as investigators in phase III or IV trials, or invited to author ghost written articles. Specialist societies may nominate them to provide expert submissions to NICE where discrimination between their personal interests and their professional interests may be difficult.
Guidelines are an ideal vehicle for gaining rapid market dissemination, particularly if they avoid mention of cost altogether,3 and are well suited for providing a niche for on-patent drugs. The potential for a positive bias towards pharmacotherapy with guidelines both based on industry sponsored trials and written by those who undertake them is considerable. Considerable interaction between the pharmaceutical industry and authors of clinical guidelines has been documented.4 Specialist society guidelines are still not invariably accompanied by a clear declaration of the nature or extent of any relevant conflicts of interest.
Figure 1.
Journal editors are culpable when bypassing peer review through the publication of industry sponsored supplements and not rigorously enforcing disclosure of conflicts of interest in other papers. Journals are obviously subject to conflicts of interest resulting from advertising revenue and the desire for large reprint orders that are used for promotional purposes, including those for guideline statements. Ensuring the integrity of professional guidelines remains a challenge to both the medical and publishing fraternities.
Establishing a process that is open, transparent, and accountable is a major step forwards for the NHS. If the NHS is to survive, NICE will have a crucial role in ensuring that the “tragedy of the commons” does not continue to be the tragedy of the health service.
Competing interests: Over the past 12 months RM has attended advisory boards for Novartis and Pfizer. Over the past 10 years RS has attended educational meetings, received travel grants, honorariums for lectures, and advisory boards from a number of pharmaceutical companies including AstraZeneca, Bayer, Fournier, GlaxoSmithKline, Pfizer, Merck, MSD, and Sanofi-Aventis. RM is a member of the British Cardiac Society and Primary Care Cardiovascular Society, and Chair of Cardiovascular Working Group of the South Asian Health Foundation, which receive funding from a variety of donors (pharmaceutical and non pharmaceutical). RM is primary care section editor for the International Journal of Clinical Practice and an appraisal committee member within the National Institute for Health and Clinical Excellence (NICE) and member of two NICE guideline development groups.
References
- 1.Ferner RE, McDowell SE. How NICE may be outflanked. BMJ 2006;332: 1268-71. (27 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Schachter M, Wierzbicki AS. Spinning stars: ASTEROID's impact on atherosclerosis. Lancet 2006;367: 1655-6. [DOI] [PubMed] [Google Scholar]
- 3.Haycox A, Bagust A, Walley T. Clinical guidelines—the hidden costs. BMJ 1999;318: 391-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002;287: 612-7. [DOI] [PubMed] [Google Scholar]