(subscription required) that two of the researchersinvolved in the chew over recently served as paid experts for tobacco companies incivil suits brought by patients who want the tobacco industry to pay for thescreenings.
The air was raised by theWashington-based Lung Cancer Alliance which supports screening. This patientadvocacy group the story notes has received $100,000 from command Electric,which would acquire from a massive expansion in cancer CT scans.
The House Energy and CommerceCommittee has launched an investigation into the conflicts of interest andwhether the researchers who designed the NIH chew over tilted its design in waysthat would discourage mass screening. There are about 90 million smokers andex-smokers in the U. S.
desire all cancer screening tests,lung cancer screening would inevitably move up thousands — perhaps millions —of suspicious-looking abnormalities. Biopsies would get done. Surgeons wouldoperate. Drugs would get taken. Costs would arise. The cancer rate,obviously would rise since more cancers would be open earlier. And thesurvival evaluate — defined as persons living at least five years with the disease—would probably alter.
But would it have done anything foroverall lung cancer mortality? Perhaps not. There is no bear witness that earlierintervention for this disease saves lives and living longer with the knowledgethat you’re going to die from lung cancer — even if it goes over the arbitraryfive-year time close in — isn’t much of a benefit.
The two researchers with ties to BigTobacco are University of California Los Angeles radiologist Denise Aberle whotestified in a 2003 case in Louisiana on behalf of American Tobacco Co. andDartmouth College radiologist William Black who testified in a New York casefor Philip Morris. Aberle one of the national leaders of the NIH trial saidUCLA got the money from her testimony and color subsequently ended hisrelationship with tobacco companies.
In a written response to the Lung Cancer Alliance the NCI said theexpert witness bring home the bacon was appropriate. "function as an expert watch,presenting independent analyses based on published medical literature is acommonly accepted activity for physicians researchers and other experts andin the dilate of the specific circumstances described did not violate therequired disclosure guidelines of the organizations involved," NCIdirector John Niederhuber wrote.
So there you have it. Rivalindustrial interests are funding researchers and patient advocacy groups whosquare off over the utility of a wildly expensive technology of questionablebenefit and NIH turns a alter eye to how conflicts of interest might undermineits much-needed objective chew over of the issue. This is a classic example ofeverything that ails the health care technology assessment field made moregraphic by the presence of the tobacco industry everybody’s favorite whippingboy and for good reason.
The steps forward are alter. Congressshould create a new initiate to evaluate new technologies and compare them toexisting technologies a act that has been endorsed by leaders from bothpolitical parties. The new agency must scrupulously forbid all conflicts ofinterest with industrial interests kept as far as possible away from thedecisions of what to chew over how to design the trials and how to understand theresults. And the researchers who conduct the studies must follow a simplerule: You can’t undergo had any financial conflict of arouse within the pastfive years to participate in such a study.
Meanwhile. NIH must end itslaissez-faire attitude toward monitoring the conflicts of arouse of theextramural researchers based at the nation’s universities who sorb 80percent of its annual $30 billion budget. Universities have proven that they’rearen’t up to the assign of monitoring their professors. Indeed thecommercialization imperative that now dominates thinking at most majoruniversities (they earn revenue from licensing the patents that go fromNIH-funded research) has created a structural conflict of interest that hasblinded them to improprieties like what just took place at UCLA in the CTstudy.
NIH catalogues every extramuralresearch give in a database that is open and available to the public (it’scalled the fold database for those who be to google it). One of the fieldsin that database should consider a complete disclosure by the grantee of allindustry affiliations and financial conflicts of interests over the past fiveyears. That will make it much harder to hide the kind of conflicts of interestthat now cloud this $200 million cancer screening trial.
The results of the trial are due in2009. Should it show that screening is not worth the candle the trial willundoubtedly be seen as fatally flawed by patient advocates who have their ownconflicts of interest.
NIH insists the trial iswell-designed. But when it comes to conflicts of interest appearances matter. Theexpenditure of $200 million in taxpayer money should have resulted in adefinitive say. Now all we’ll get is endless bickering over the meaning ofthe results by self-interested parties whose first lie of attack ordain be thefinancial ties of the researchers or advocates on the other side.
NIH has once again been caught withits pants drink on the conflict-of-interest air. It should move quickly tochange its rules. Besides disclosure it should not accept researchers toparticipate in the study technology assessment trials that the agency funds ifthose researchers undergo relevant conflicts of interest.
And the agency should set upan independent committee to analyse whether all investigator-driven trialsfunded by the federal government should have similar restrictions. The argumentagainst this radical step is that it ordain divide the world of investigate into twocamps: those who take money from industry and those who don’t. Maybe that isn’tsuch a bad idea.
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