Industry influences on expert panels contribute to over-diagnosis

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1. Over the past decade, 63% of panels proposing changes in disease definitions elected to widen the definition, potentially fueling over-diagnosis.

2. In most of these panels, panelists are healthcare professionals with ties to multiple pharmaceutical companies.

Evidence Rating Level: 2 (Good)

Study Rundown: Over the past decade, the public and medical communities alike have paid increasing attention to the financial ties between pharmaceutical companies and health professionals. This attention has led to numerous efforts to limit the impact of pharmaceutical companies on research, medical education, and clinical care. This study looked at industry’s influence on workgroups that set clinical practice guidelines, and found that most panels making recent decisions on definitions of common conditions in the US have proposed widening definitions and that majority of these panels’ members had multiple ties to the pharmaceutical industry. These findings, in combination with previous studies demonstrating that such conflicts of interest lead to non-evidence-based recommendations , support the notion that biased panels are contributing to overdiagnosis of common diseases in the US.  Future policy decisions on the diagnostic criteria of a given disease, and thereby its prevalence, must at least explicitly discuss the harms and benefits that industry may sustain as a result of definition changes so that the entire working group can determine whether proposed changes will actually improve patient outcomes.

Click to read the study in PLOS Medicine

Relevant Reading: Conflict of interest in clinical practice guideline development: a systematic review

In-Depth [cross-sectional study]: This study aimed to identify national and international guidelines in which disease definitions were changed, assess whether proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of panel members’ industry ties. The study included guidelines on diagnostic criteria of common diseases published between 2000 and 2013.

Sixteen articles were included in the study, of which 10 widened disease definitions, one narrowed, and five had unclear impact. Disease definitions were widened either by lowering diagnostic thresholds; creating “pre-disease;” or proposing earlier diagnostic methods. Panels varied in how explicit they were about their rationales for expanding definitions; less than half mentioned potential harms to proposed definition changes such as over-diagnosis. Fourteen panels disclosed industry ties, with an average 75% of members tied to industry.

By Elizabeth Kersten and Andrew Bishara

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