The stated intent of treatment guidelines is to "guide" clinicians' treatment of patients with a series of recommendations based on evidence.
But that intent may not be universally reflected in published guidelines and the disconnect is all about money.
Doctors with financial ties to drug companies have heavily influenced treatment guidelines, an analysis by the Milwaukee Journal Sentinel and MedPage Today has found.
Critics say those financial relationships have corrupted the guideline process so that the end products, make dangerous or ineffective recommendations.
Industry and some doctors counter that those with conflicts are often top experts in their field.
The Journal Sentinel/MedPage Today examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the U.S.
Search top-selling drugs, guidelines and doctor conflicts on JSOnline.com
These drugs sit in the medicine cabinets of millions of Americans -- Nexium (esomeprazole magnesium) for acid reflux, Lipitor (atorvastatin) for high cholesterol, Cymbalta (duloxetine) for depression, and OxyContin (oxycodone) for pain. Their collective sales topped $94 billion in 2011, accounting for 30% of drug revenue in the U.S.
An analysis of the guideline panels, which involved 293 doctors, found:
Nine guidelines were written by panels where more than 80% of doctors had financial ties to drug companies. Four panels did not require members to disclose any conflicts of interest. Of the 16 guideline committees that required disclosure, two-thirds of the panel members had ties to drug companies. Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing, specifically guidelines for anemia, chronic pain, and asthma.
In this analysis, research funded by drug companies was not counted as a conflict in the Journal Sentinel/MedPage Today analysis because there is disagreement about whether research funding poses as much of a conflict as speaking, consulting and advising.
The findings offer the latest glimpse into how pharmaceutical companies, with billions in sales at stake, exert a powerful but often unrecognized influence over the practice of American medicine.
Past Journal Sentinel/MedPage Today reports have revealed articles in medical journals that were ghostwritten by drug company marketers; instructional videos for doctors that made misleading claims about drugs; payments to medical organizations that advocated for more use of drugs; and drug companies paying for continuing medical education courses that, in essence, market their products.
"At the end of the day, the drug companies own medicine," said Eric Campbell, PhD an associate professor at Harvard Medical School who has researched conflicts of interest in treatment guidelines. "We've created a system that allows this."
In March 2011, the Institute of Medicine issued a report that said fewer than 50% of members of a guideline-writing committee should have financial relationships with drug companies. No committee chairman should have a financial conflict of interest, the IOM said.
In this Journal Sentinel/MedPage Today analysis just two guideline committees met the IOM criteria. Of the 16 panels that disclosed conflicts of interest, at least 10 had chairmen with financial ties to drug companies. Payment amounts were not disclosed in the guidelines, which were issued between 2001 and 2012.