The New York Times reports on conflicts of interest on three panels writing clinical guidelines for the National Institutes of Health, including cholesterol, hypertension and obesity. The article notes “At least eight of the 19 members of the obesity panel have financial ties to a phalanx of private business interests.” The companies listed include GlaxoSmithKline which makes Alli (over-the-counter version of Xenical), Allergan (maker of Lap-Band), Nestle and Weight Watchers. “One (panel member, not identified), is paid to speak or advise 11 companies with obesity products.” Potential Conflicts on U.S. Health Guideline Panels – NYTimes.com

In my opinion, the latter point here is important. The people picked for these guideline writing groups are often clinical researchers. Usually they are at academic centers with clinical facilities which attract patients who companies need to be included in a valid clinical trial of their product. The fact is that, in the obesity field, there is not a large pool of such clinical researchers. Few can exist on NIH funding alone, or on clinic fees alone, for that matter. So, it is natural that companies with products under development come to these centers for clinical trials. 

Some years ago, a case could have been made that too many researchers on such panels were working for  a few pharmaceutical companies. Now, many pharmaceutical companies have disbanded their research and development activities. The companies left in the market are too small to exert much influence.

As a result, many of these researchers have worked for multiple companies who are competitors. The companies are not monolithic interests. Device companies compete with drug companies who compete with behavioral care providers; medical providers compete with non-medical providers. (Another point is that many also do work for food and beverage companies.) So it would a real surprise if one of these conflicted researchers were to, in effect, burn their reputation and prospects for future research, to shill for one of many companies in a complex market. Might happen, can’t say it won’t. But then again, this would be evident not only to the other 18 members of the panel but the staff of NIH as well. Oh, did I mention the staff are often involved in funding these researchers? It would have been interesting for the writer to ask how many were funded by NIH, CDC, Robert Wood Johnson Foundation and other, non-commercial interests.

As mentioned in an earlier post, the medical device makers looking at the obesity market are taking their research OUS, outside the United States to avoid the extra costs and time in the US regulatory schema.

The public and other health professionals have a right to expect that clinical guidelines are free of undue influence which would change the recommendations from that as indicated by the scientific literature. But they also have a right to expect guidance from leading experts whose range of experience, even in the commercial sector, gives them invaluable information. The NIH and FDA will, no doubt, continue to grapple with this problem.