Most Americans believe that the recommendations their doctors make are based on solid science and have their best interest at heart. To make those decisions, many times doctors use guidelines when trying to chose what care should work best. Given that the ACA places such a premium on doctors adhering to guidelines, what gets into these documents greatly impacts your healthcare. This is why a new research paper that exposes the serious conflicts of interests found in orthopedic guidelines is so concerning.
If you’re like most people, you may not even know too much about guidelines. They’re the behind the scenes instruction book that your doctor is supposed to follow to decide what type of healthcare you get. So for instance, which medication gets prescribed if you have knee arthritis, or what gets injected, or which surgery you undergo. You may also be unaware that the Affordable Care Act forces the reliance on guidelines to a whole new level. Now these instruction sets and how well your doctor follows them are linked to how your doctor gets paid. So if guidelines are the strings in the puppet show of your healthcare providers, whose creating the guidelines and their conflicts of interests are the people pulling those strings. Regrettably a recent research paper exposed that the people pulling the strings aren’t necessarily making decisions based on what’s best for you, but more likely what’s best for them.
The research was a systematic review of the US National Library of Medicine of all of the orthopedic guidelines on hip and knee arthritis that had been recently published. The guidelines were first graded based on how solid the scientific evidence was that supported the document. The researchers also examined the conflicts of interest of the doctors writing the guidelines and whether they really had any despite what they reported. What did they find? 50% of the hip/knee osteoarthritis guideline recommendations were based on lower quality evidence. A conflicts of interest (COI) occurs when a doctor making a recommendation has accepted money or other things from a company who would financially benefit if the doctor recommended that drug or device. Nearly half the guidelines failed to disclose relevant COI and when disclosed, multiple potential conflicts were found. In fact, an average of about 30 COI per guideline!
The upshot? Conflicts of interest in medicine are ubiquitous and often under reported by physicians. I can’t tell you how many conferences I’ve attended where I knew the speaker was working with X company and that fact was never disclosed. Having said that, these new revelations of serious COI in arthritis treatment guidelines take on a new meaning now that doctors are increasingly being forced to treat patients based on guidelines. At least when physicians were free to practice as they saw fit and decide on their own what was best for the patient, the fact that the guidelines were corruptible had less impact!