Setting guidelines for medical diagnosis and practice

The majority of health professionals in the United States who sit on guideline panels deciding the definitions or diagnostic criteria for common conditions have financial ties to pharmaceutical and medical device companies, a study has found.

The researchers identified 16 publications by national and international guideline panels that had been published between 2000 and 2013 on the diagnosis of 14 common conditions. Of these, 10 proposed changes widening diagnostic definitions, one narrowing definitions, and the impact of the other five was unclear.

Conditions that had their definitions expanded included high blood pressure, Alzheimer’s disease, and rheumatoid arthritis. Panels widened definitions by creating pre-disease conditions, lowering diagnostic thresholds, or proposing earlier or different diagnostic methods. The rationale they gave for the changes included standardising diagnostic criteria and new evidence about the risks to people previously not considered to have the disease.

On average 75% of members of 14 guideline panels with disclosure sections admitted to ties to industry, commonly working as consultants, advisers, and speakers, as well as receiving research support. Twelve of the 14 panels were chaired by health professionals with ties. Health professionals with industry ties had links to a median of seven companies. Companies with the highest proportions of ties manufactured drugs used to treat the disease in question.

Text from the Johns Hopkins Berman Institute of Bioethics.   The full report is published in the British Medical Journal (BMJ 2013;347:f4998).