CJASN
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Clin J Am Soc Nephrol 2: 212-, 2007
© 2007 American Society of Nephrology
doi: 10.2215/CJN.0660207
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kassirer, J. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kassirer, J. P.

Commentaries in Response to Controversies in Nephrology

Stacking the Deck

Jerome P. Kassirer

Tufts University School of Medicine, Boston, Massachusetts

Address correspondence to: Dr. Jerome P. Kassirer, Distinguished Professor, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111. Phone: 617-636-6523; Fax: 617-636-0375; E-mail: jerome.kassirer{at}tufts.edu


   Introduction
Top
 Introduction
Disclosures
 References
 
When the leaders of the National Kidney Foundation (NKF) appointed the heavily conflicted 2006 Kidney Disease Outcomes Quality Initiative (KDOQI) anemia work group, were they oblivious to the possibility that ANY recommendation of the panel would be considered suspect? Surely they knew not only that Amgen was the founding and principal sponsor of the guideline development (1), but that the chair and vice-chair of the KDOQI steering committee and both co-chairs of the work group were consultants for Amgen, Ortho Biotech, or both (2). To compound the financial conflicts, 11 of the 15 members of the work group had similar arrangements (1,3). And of the 40 or more KDOQI advisory board members who reviewed an early draft of the guidelines (2), how many of them (or the NKF officers) had similar financial conflicts? What an ideal setup for group-think (4)!

Van Wyck and colleagues dismiss the worries over using financially conflicted panelists (5). Their argument that lots of constraints can skew guideline development is true, but irrelevant, because all the factors they cite are intrinsic to the scientific process. Financial conflicts and their attendant biases are not, because panel members can be selected who have eschewed such arrangements. They also assert that it is unrealistic to expect unconflicted experts to develop guidelines (I call this notion the "fallacy of unique expertise") (4), and even if such were possible, then journal editorial board members should also be free of financial ties (sounds good to me). Then they claim that research quality and patient care will suffer from reliance on experts not associated with industry (5). No evidence is adduced for this argument.

Other proponents of allowing conflicted physicians to participate in guideline development make two arguments. One, anyone who is an expert is already on the payroll of a company. Two, medical education and advice should not be sought from those who are not the best and the brightest, namely those whom industry has passed by (6). The first, if true, means that virtually the entire nephrology community has been co-opted by industry—a truly depressing allegation. The second argument is elitist and condescending; industry selects consultants and speakers not just based on meritorious or intellectual attributes, but for traits that favor the company’s marketing objectives.

I come down squarely on the side of Coyne and others on this issue (1,7,8–11). The NKF policies are woefully deficient to protect against allegations of bias or actual existence of bias. I believe that guideline committees should be composed of members without financial ties to companies whose products are considered in their deliberations. Recusing members from participating or voting is no reassurance that bias will be minimized. I would allow financially conflicted members, even industry employees, to offer advice to the committee, but not to formulate policy (4).

When will professional organizations learn that if they stack the deck with financially conflicted panelists, their recommendations will be suspect and their reputations as fair arbiters of science will be sullied? Can’t find a few good men or women who have resisted the powerful magnet of industry’s deep pockets? Try harder; they’re out there.


   Disclosures
Top
 Introduction
 Disclosures
References
 
None.


   Footnotes
 
Published online ahead of print. Publication date available at www.cjasn.org.


   References
Top
 Introduction
 Disclosures
 References
 

  1. Coyne DW: Influence of industry on renal guideline development. Clin J Am Soc Nephrol2 :3 –7,2007[CrossRef][Medline]
  2. Van Wyck D, Eckardt K-U, Uhlig K, Rocco M, Levin A: Appraisal of evidence and control of bias in the kidney disease outcomes quality guideline development process. Clin J Am Soc Nephrol2 :8 –10,2007[CrossRef][Medline]
  3. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis47 :S11 –S145,2006[CrossRef][Medline]
  4. Kassirer JP: On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health. New York, Oxford University Press,2004 , pp204 –205
  5. Van Wyck D, Eckardt K-U, Uhlig K, Rocco M, Levin A: Response to "Influence of industry on Renal Guideline Development." Clin J Am Soc Nephrol2 :13 –14,2007[CrossRef][Medline]
  6. Stossel TP: Regulation of financial conflicts of interesting medical practice and medical research: A damaging solution in search of a problem. Perspect Biol Med50 :54 –71,2007[CrossRef][Medline]
  7. Coyne DW: Practice recommendations based on low, very low, and missing evidence. Clin J Am Soc Nephrol2 :11 –12,2007[CrossRef][Medline]
  8. Narins RG, Bennett WM: Patient care guidelines: Problems and solutions. Clin J Am Soc Nephrol2 :1 –2,2007[CrossRef][Medline]
  9. Brennan TA, Rothman DJ, Blank L, Blumenthal D, Chimonas S, Cohen JJ, Goldman J, Kassirer JP, Kimball H, Naughton J, Smelser N: Health industry practices that create conflicts of interest: A policy proposal for academic medical centers. JAMA295 :429 –433,2006[Abstract/Free Full Text]
  10. Kassirer JP: Professional societies and industry support: What is the quid pro quo? Perspect Biol Med50 :7 –17,2007[CrossRef][Medline]
  11. Steinbrook R: Guidance for guidelines. N Engl J Med356 :331 –333,2007[Free Full Text]



This article has been cited by other articles:


Home page
 CJASNHome page
K. L. Johansen
Value of Quality Improvement Reporting
Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1104 - 1105.
[Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kassirer, J. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kassirer, J. P.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS