Seems we’ve heard this before

Seems we’ve heard this before

“The prevalence of financial conflicts of interest and their under-reporting by members of panels producing clinical practice guidelines on hyperlipidaemia or diabetes was high, and a relatively high proportion of guidelines did not have public disclosure of conflicts of interest. Organisations that produce guidelines should minimise conflicts of interest among panel members to ensure the credibility and evidence based nature of the guidelines’ content.”  This was the conclusion drawn by a study in the British Journal of Medicine.

The authors went on to state:

“Although most organisations mandate some form of disclosure, complete transparency is often not achieved, and simple disclosure of conflict of interest (COI) may not be enough to prevent panel members’ bias from influencing recommendations. Emphasising the importance of having unbiased recommendations to guide clinical practice, the Institute of Medicine recently published recommendations on management of COI among authors of clinical practice guidelines. These recommendations call for the exclusion of panel members with financial COI, the appointment of a chair without COI, and an end to direct funding of guidelines by industry. They also recommend full disclosure of the COI policy of each guideline panel, along with the potential COI of all panel members. Lastly, they recommend that if appointing panellists with COI is unavoidable, their presence should be limited to a minority and they should be prohibited from voting.” (Bold added by Diabetic Investor)

This past Wednesday Diabetic Investor posted a piece entitled “Hypocrisy reaches new heights” where we reviewed the role played by Dr. David Klonoff in the clinical practice guidelines issued by the Endocrine Society for the use of continuous glucose monitoring systems (CGMs). As we noted in the piece Dr. Klonoff was not just the chair of the committee that wrote these new guidelines, he’s  also the Medical Advisor for C8 MediSensors, a company which is developing a non-invasive CGMs.

Now before we go any further here Diabetic Investor wants to make clear that we do not necessarily have a problem with any expert participating on panels such as these provided they fully disclose all their relationships and possible conflicts of interests. We should further point out, as we did on Wednesday, that all the committee members who came up with the new guidelines did disclose any possible conflicts of interest. Lastly we believe it would be impossible to find qualified experts willing to participate on committees such as these that don’t have some potential conflicts of interest.

Quite frankly it is naïve to believe that just because an expert does not have any conflicts of interest that somehow their views are pure and do not contain any bias. It is equally foolhardy to believe that just because an expert has done work for or holds stock in a particular company that their view is biased toward this company. Diabetic Investor has had the pleasure of meeting several of the experts who have served on committees that have developed clinical practice guidelines and we can state for the most part these experts come to the table with an open mind and their main goal is to do what’s best for the patient. Yes, there are always bad apples in the bunch but for the most part these experts put science ahead of their own financial interests.

What concerns Diabetic Investor, as we noted on Wednesday, is when people like Dr. Klonoff seem to be speaking out of both sides of their mouths.  We also find it disturbing that someone as distinguished as Dr. Klonoff would basically throw the guidelines which he helped develop under the bus after they are announced. If Dr. Klonoff truly believes that CGMs are too expensive and not accurate enough, then he should tell the good folks at C8, who plan on charging $4,000 for their system and  who have yet to publish a credible data set, exactly how he feels.  Diabetic Investor also questions why, if he truly feels this way, the good doctor would even associate himself with the company.

As Diabetic Investor has noted previously Dr. Klonoff is not the only “expert” who has blurred the lines of integrity. Diabetic Investor has documented the words of Dr. Steven Nissen, the famed crusading cardiologist, who has fallen in love with his opinions and seems to believe that if you don’t agree with his views you’re basically an idiot. Perhaps Diabetic Investor has totally lost it, but in the America we live in there is nothing wrong with holding a contrary viewpoint. As Dwight Eisenhower once said; “Here in America we are descended in blood and in spirit from revolutionaries and rebels- men and women who dared to dissent from accepted doctrine. As their heirs, may we never confuse honest dissent with disloyal subversion.”

Integrity is not like an umbrella, something that you only use when it’s raining. Or as Samuel Jackson noted; “Integrity without knowledge is weak and useless, and knowledge without integrity is dangerous and dreadful.”