The US National Institutes of Health (NIH) has been urged to “seek balance” when it convenes panels of experts to write clinical practice guidelines, and to ensure that all panellists are free from financial conflicts.
The controversy has arisen because, out of the five physicians who are set to lead sessions at a February 20 conference being organised by the National Institutes of Allergy and Infectious Diseases to write guidelines for prevention of neonatal herpes, four have direct financial relationships with GlaxoSmithKline. As the manufacturer of the antiviral Valtrex (valacyclovir), GSK stands to gain if the conference recommends broader testing of pregnant women for herpes, says a letter to NIH director Elias Zerhouni and other officials, signed by over 40 physicians and scientists and more than a dozen health organisations.
Obstetricians and gynaecologists are sharply divided over whether all pregnant women should be tested for herpes, given that neonatal transmission of herpes is relatively rare, notes the Center for Science in the Public Interest (CSPI), which organized the letter. Articles and letters questioning universal testing, which would almost surely lead to more women being prescribed Valtrex, have recently appeared in The Lancet and leading journals, it adds.
“Given the controversy surrounding this subject, we were surprised to see the lineup of speakers for the…meeting, which…did not reflect the diversity of views on this subject. Nor did the invitation reveal the conflicts of interest of virtually every invited presenter,” says the letter, whose signatories include The Lancet’s editor-in-chief, Richard Horton, former editors of the New England Journal of Medicine and physicians, consumer organisations, scientists and health professionals.
The letter describes the NIH as “the crown jewel in the nation’s medical research establishment” but calls for it to have a higher standard. “NIH must serve as an honest broker in the development of medical evidence that will inform clinical practice. When holding conferences aimed at writing guidelines, it should seek balanced presentations. When appointing guideline writing committees, it must strive to ensure that all members are free from conflicts of interest,” say the signatories. However, they add: “several centres and institutes at NIH routinely ignore these common-sense standards.”
According to the CSPI, this is not the first time that NIH has convened guideline-writing panels that had members with ties to companies that stand to lose or gain from the panels’ recommendations. Panels having to do with managing cholesterol, hypertension and HIV/AIDS have all had large numbers of industry-funded researchers serving on them, it says.
“NIH shouldn’t let drug company-affiliated doctors write the rules, and it shouldn’t stack the deck to make it look like there is medical consensus on something when there’s not,” commented Merrill Goozner, director of the Integrity in Science Project at CSPI, which maintains a database of industry-funded scientists. By Lynne Taylor