During the 2016, after 8 years of politicians refusing to work together, it may surprise you to learn that other groups do consult experts outside their own circles. It won't surprise you to learn a group of academics think that's a bad thing, and that cancer care guidelines should never meet with the companies that actually create cancer care.
Yet that's what the University of North Carolina Lineberger Comprehensive Cancer Center sets out to do, and does; they think that any consulting means scientists and doctors are for sale.
Is that simplistic narrative really true? Perhaps on television shows. But perhaps almost 9 out of 10 researchers who helped create the cancer care guidelines were chosen because they are the best in the field, the same reason they get paid to be on panels by industry. The authors analyzed payments in 2014 to physicians who helped write the National Comprehensive Cancer Network's (NCCN) guidelines. It's publicly-available data reported through Open Payments, a federal program required by a provision of the Patient Protection and Affordable Care Act that requires U.S. drug and device manufacturers to disclose transfers of financial value greater than $10 to physicians and teaching hospitals.
Of the 125 panelists who worked on setting the NCCN guidelines for lung, breast, prostate and colorectal cancer, 108 received some form of industry funding, the authors in JAMA Oncology intone conspiratorially. Yet they only know this because the doctors and companies disclose it. Obviously if they were unethical, they would not disclose any potential conflict of interest, the way the International Agency for Research on Cancer didn't disclose they had a paid consultant for Environmental Defense Fund on the Working Group to declare the pesticide Roundup a carcinogen.
But what counts as payment? Any expense related to being on the panel. So to these academics, any doctor who does not fly to attend a speaking panel using their own money is suspect. No one would ever agree to a talk on those conditions. Maybe Chelsea Clinton, who charges $60,000 but doesn't care if you pay her to talk or not, because money is so unimportant to her.
The NCCN sets limits for how much physicians can receive in payments from industry and participate in setting the guidelines to reduce the risk of financial conflicts. Guideline authors cannot receive $20,000 or more from a single company or $50,000 or more in total. The researchers found in their analysis that eight physicians, or 6 percent, appeared to exceed the NCCN's financial conflict of interest limits.
Guidelines don't prevent unethical behavior. The academics criticizing cancer experts still wouldn't know it except they were ethical enough to report it.
"The prevalence of financial relationships was fairly high among physicians who authored these cancer treatment guidelines. Knowing this, it will be important to ask whether those relationships influence the recommendations that guideline authors make," said Aaron Mitchell, MD, the study's lead author and a clinical fellow in the UNC School of Medicine Division of Hematology/Oncology.
Dr. Mitchell is asking if they have stopped beating their wives yet. Unfortunately, government guidelines have no position on doing that.