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Who Decides Medical Treatment - Doctors or Drug Companies? 
Imagine this: the judge in the Microsoft anti-trust trial is on Microsoft's payroll to the tune of $500,000 per year. Will his judgment be impartial? Hard to imagine, right? Yet this kind of conflict of interest is common in the medical field, and it shouldn't be tolerated any longer, says Dr. Malcolm Kendrick. The doctors who sit on the National Institute of Health (NIH) panels charged with making medical treatment and prescription guidelines are the same doctors who are paid serious money by pharmaceutical companies to run the drug trials, publish articles containing the results, and make presentations at elaborate conferences. These opinion leaders invariably reach their pinnacles of prestige and influence through the money earned from consulting for pharmaceutical companies. Their recommendations are followed by the thousands of doctors who spend their days caring for patients instead of caring for companies. Until recently, the frontline doctors were unaware that those government guidelines were contaminated by the biases of pharmaceutical-company-employed opinion leaders. Such an inevitable conflict of interest is accepted as a commonplace arrangement by the industry and the government health agencies. What would be considered a flagrant conflict of interest in any other setting is seen as actually desirable in the world of medicine. The argument is that because there are so few medical experts, it is not unusual for their expertise to be required by both those who make the drugs and those who make the guidelines about how to treat/medicate illness. Cardiologists are among the doctors most caught up in this lucrative arrangement. They can make up to $100,000 in speaking fees and expense accounts over a five day conference. When the National Cholesterol Education Panel (under the aegis of NIH) released new cholesterol guidelines encouraging the use of statins for lowering cholesterol levels, no disclosures were made as to the panelists' affiliations. When pressed by Dr. Kendrick, the NIH reluctantly revealed that all of the panelists were on the payroll of various statin-producing companies. That's to be expected because they are the only experts, right? But Dr. Uffe Ravnskov is a good example of one expert whose research questions the wisdom of using statins for cholesterol management. Yet, not surprisingly, he and others with similar conclusions in statin research were not asked to serve as a moderating (unpaid) voice on the panels. Is that coincidence or just good business on the part of the pharmaceutical companies -- and scandalous complicity on the part of our national health institutes?
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