IBD Treatment Guidelines Are Often Influenced By Financial Gains

The publication Gastroenterology & Endoscopy News published an article based on a new study that indicates many authors of clinical practice guidelines for inflammatory bowel disease (IBD) have financial conflicts of interest.  Are you surprised? I’ve suspected this for years and am glad, and saddened that a study found this to be true. Glad because with this information now public the standards will hopefully raise the standards and put patient care first and foremost. Saddened because I can only imagine how many Crohn’s and Colitis patients have received substandard care, misguided treatments that could have resulted in unwanted surgery, or perhaps worse.

According to their website, Gastroenterology & Endoscopy News is a number 1-rated independent monthly newspaper providing news and information for more than 20,000 gastroenterologists, colorectal surgeons, hepatologists, physician assistants and nurse practitioners.

The study examined eight IBD guidelines from major GI organizations in the United States, Canada, and Europe. The two conditions of conflict of interest they looked for were:

1) Less than 50% of committee members in charge of guidelines have any financial conflicts of interest
2) All committee chairs are free of such conflicts

Only THREE of the eight IBD guidelines published met both conditions! This sickens me to my stomach! How long has this been going on? How many more of us have to suffer before the committee members and chairs open their heart, feel empathy and compassion for the millions who live with the challenges of IBD on a daily basis.  When Doctors put their wallets and bank accounts before thinking about what’s best for the individual patient, who knows what could happen – except for an upgraded BMW parked in their driveway and a third vacation home in the Bahamas. On the average US gastroenterologists make $408,000 per year according to a 2018 report.  I don’t know what the committee members in charge of the guidelines or the committee chairs make per year, but a Senior Director at the American Gastroenterological Association make around $125,000 per year, so an educated guess is that the committee members and chairs make significantly more than low six figures. For reference, the median household income in the US was $61,372 according to the 2018 survey conducted by the United States Census Bureau.  So let me get this straight, not only do these committee members and chairs make at least double the income of the average patient, they are also receiving additional financial benefits(i.e. fraud), that jeopardizes the health and financial well-being of their patients.

Back to the Conflict of Interest in Inflammatory Bowel Disease Clinical Practice Guideline conditions….I don’t believe under 50% is enough. If 49% of the members didn’t have any financial conflicts of interest would that make things right? How about 30 or 20%? Why should ANY committee members have financial interests that could possibly hurt and negatively effect patient care?  Maybe we need to send them a Snapchat of someone with IBD in a bad flare and their dozens of bowel movements a day to help them see what it’s like to live with IBD, and to have more compassion and not steal money that could easily result in negative patient outcomes.

When I worked for Raytheon we were not allowed to keep any item from a vendor that cost more than $20. My boss Dan Horvath once sent back a fudge cake a prospective vendor sent us as he didn’t want the delicious chocolate fudge cake to influence our decision for the computer system we were evaluating.  His level of integrity has stuck with me and influenced many of my decisions.  As Lead Hardware Engineer for a $MM surveillance system I was responsible for a mission-critical project that protected our freedom and lives. Similar to Doctors, committee members, and chairs responsible for recommending guidelines that hopefully save lives.

With great power comes great responsibility. #IBD guidelines influenced by personal financial gains https://www.onegreatgut.com/ibd-guidelines-often-saddled-with-author-conflicts/ #sa1000 #doctors #BSG #AGA #doctor… Click To Tweet

Of the three guidelines that met the two conditions above, two were published by the American Gastroenterological Association (AGA) and one by the British Society of Gastroenterology (BSG), according to the researchers. The remaining five guidelines did not meet either condition, according to the findings, which were presented at the 2018 Digestive Disease Week (abstract Sa1000).

Canada has the highest prevalence of Crohn’s and ulcerative colitis, and none of their guidelines met the two(lenient) conditions the researchers were looking for. This.Is.Disgusting!

Conflicts of interest could lead to over-treatment of costly medications and lead to less trust of the guidelines. How about the finances of patients? A Harvard University study found that the #1 reason Americans file for bankruptcy is due to medical expenses. A large part of those even had health insurance.  When a Doctor follows a treatment guideline that the patient follows which includes over-treatment of costly medications, this potentially unneeded expense could lead families to bankruptcy unnecessarily. And then there’s the possibility of additional unwanted adverse effects due to over-treatment, which could result in additional diagnoses and expensive hospital visits.

Doctor’s have power over guidelines and treatment care that affects the lives not only of their patients, but their families, finances, children and community.

We need a higher level of integrity when it comes to IBD guidelines. https://www.onegreatgut.com/ibd-guidelines-often-saddled-with-author-conflicts/ #sa1000 #doctors #BSG #AGA #doctor #crohns #IBD #colitis Click To Tweet

The findings may partly reflect the close interactions between IBD physicians and biologic companies said Dr. Samir Grover, MD, an assistant professor in the Department of Medicine at the University of Toronto, who helped conduct the study.

In addition, Dr. Grover said he and his colleagues did not account for potential undeclared conflicts of interest because the data for the study relied on disclosed conflicts of interest. With the integrity of the committee members already suspect, can we trust them to declare all conflicts of interest? Dr. Grover suspects that the financial conflict of interest is higher than what they found. Other fields other than gastroenterology have found undeclared financial interests do exist, and they do have an influence to how doctors practice.

I look forward to a day where ALL doctors and committee members put the patients healthcare before their bank account.

If you’re in shock as I was when I learned of this, consider printing this blog, the article and study to give to your doctors asking them to look into this and try and up-level treatment guidelines. It’s the doctors at the front line who see every day the effects of IBD on their patients.  Perhaps they can help advance a much needed peaceful healthcare revolution. Revolutions start with the bottom, those negatively affected by actions of those up top.

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