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The Boston Globe on Tuesday examined controversy over heart disease detection guidelines published recently in a paid supplement to the American Journal of Cardiology. The guidelines recommend that all men ages 45 to 75 and women ages 55 to 75 receive screenings -- as well as follow-up tests years later -- to detect calcium deposits in blood vessels and measure blood flow to the brain. The recommendations, if followed nationwide, would affect 50 million people and cost more than $25 billion. According to the Globe, "Such a seismic shift in medical practice" typically comes from a government agency or a "major" professional organization, but these recommendations were made in a supplement funded in part by Pfizer, which sells the cholesterol treatment Lipitor. Meanwhile, the effectiveness of the screenings as a tool for improving detection of cardiovascular disease has not been studied in clinical trials. According to the Globe, the authors of the recommendations "got tired of waiting for the support" of the American Heart Association and the American College of Cardiology, so they submitted their recommendations to the American Journal of Cardiology. Journal editor William Roberts declined to publish the recommendations, saying instead that they could appear as a paid supplement to the publication. Morteza Naghavi, lead author of the recommendations and a cardiologist at the University of Texas-Houston, then sent letters to six drug companies soliciting funding. In response, Pfizer provided $55,800 for the group to publish the supplement. Reaction Jerome Kassirer, former editor in chief of the New England Journal of Medicine, said, "The whole thing sounds like a conflicted mess, from the recommendations that they're making to the issue of how these journal supplements work." According to the Globe, the American Journal of Cardiology is not the only journal to publish paid supplements, although the "highest-tier" journals, such as the New England Journal of Medicine and the Journal of the American Medical Association, do not publish such supplements. Christine Laine, senior deputy editor of Annals of Internal Medicine, said, "If someone approached us and said, 'We want to publish this supplement on hypertension, and it's funded by Pfizer,' we would say, 'We don't do that.' Our readers would be naturally suspicious that that content is biased." P.K. Shah, leader of the task force that created the recommendations and director of cardiology at Cedars-Sinai Medical Center, said that although the science behind the guidelines "needs to be proven," the authors "are hoping this will stir up enough interest that we can get agencies that have the capacity to fund such a study to do a study." Diane Bild, a medical officer at NIH's National Heart, Lung and Blood Institute, said specialists at the institute have rejected a study comparing patients who receive high-tech screenings to others because it "would be very expensive to conduct, and it just hasn't reached that level where we've gone forward with it." Naghavi defended the donation from Pfizer, as well as money from pharmaceutical companies that paid for the coauthors' airfare, meals and hotel rooms during a meeting in California. He said, "It's not a Pfizer-driven guideline. It's a guideline driven by frustration." A Pfizer spokesperson said, "Pfizer feels it is important to provide support for efforts that assess novel approaches to reduce the burden of heart disease" (Smith, Boston Globe, 7/25). You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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