09 September 2013

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).


  1. while there is the problem of pharmaceutical companies want to sell us more drugs so they can make money, on the other hand expanding the diagnosis threshold or creating a "pre-condition" can sometimes mean the difference between a thing that would help you and a thing that will help you that's covered by your insurance.

    best way to combat greedy advantage-taking is transparency.

    and questions.

    always ask: do i really need this? is this really a risk? is there a non-drug alternative?

  2. Or alternately, is there a non-SURGICAL alternative. I was scheduled for a bowel resurrection back in June 2008, but luckily for me, it was scheduled in early May for late June, and on June 1st, 2008 I was hit with a blood clot (it's still there) that forced a "suspension" of the surgery. It still has not happened, mostly because a cocktail of medicines have both alleviated the symptoms, and both them, and time have greatly reduced both the number and size of the polyps in my colon.

  3. On the systemic problems of the medical system at large (not specifically US, by the way) I can't recommand enough reading "Bad Pharma" by Ben Goldacre: it's comprehensive, documented and damning. Best of all, it proposes clear guidelines to get out of this mess...

    See also the All Trials campaign http://www.alltrials.com/


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