Can We Trust the Independence of Cardiovascular Guidelines?

See Article by Dudum et al Over the last several decades, industry payments to physicians have come under considerable public scrutiny.Several extraordinary cases were documented by investigative journalists and Congressional Committees during the decade from 2000 to 2010.In 2008, in a particularly infamous case, Senate Finance Committee Chair Sen. Chuck Grassley (R-IA) alleged that a prominent Harvard psychiatrist had received $1.6 million over several years from pharmaceutical companies but did not report much of this income to university officials.1 Potential conflicts of interest between industry and authors of practice guidelines also received considerable attention during this decade.A study in 2002 documented that 87% of guideline authors had relationships with an average of 10.5 companies.2 Even after a decade of public scrutiny, a subsequent study published in 2011 reported that 56% of 598 cardiovascular guideline writers self-reported a relationship with industry.3 The public outcry about these industry relationships resulted in a 2011 report by Institute of Medicine report addressing the issue of producing trustworthy clinical practice guidelines.4 The public attention also resulted in major changes in the policies of many professional medical societies, including the American College of Cardiology (ACC) and American Heart Association (AHA).5 Initially, policies focused on accurate reporting of relationship with industry but evolved to including efforts to limit the extent of industry involvement among guideline writers.However, the most important transparency initiative was the introduction of bipartisan legislation in 2007 by Sens. Grassley and Herb Kohl (D-WI), the Physician Payments Sunshine Act, which was finally passed by Congress in 2010 as part of the Patient Protection and Affordable Care Act.6 This landmark legislation required reporting of payments made to physicians by the medical industry.Providing the necessary infrastructure for public reporting of payments took several more years.Finally, on September 30, 2014, the Centers for Medicare and Medicaid Services began reporting payments to physicians via a publicly available website that initially included data from 2012.It was the hope of the Congressional sponsors of this legislation that the sunshine provided by mandatory disclosure would automatically result in physicians accurately reporting relationships with industry.Putatively, knowledge that all industry relationship would be disclosed via a publicly available website should ensure that physicians, including guideline writers, would be highly incentivized to accurately report payments received.Likewise, the ACC and ACC assumed that strict policies regarding conflicts of interest would result in the production of guidelines untainted by allegations of improper industry influence.The current article by Dudum et al 7 suggests that these efforts have not been entirely successful.