Should we Trust the New Cholesterol Guidelines?

By Christopher Robertson

The new American Heart Association and American College of Cardiology guidelines on how patients should manage their cholesterol are likely to dramatically increase the sales of statins.  (E.g., check out the bump to Pfizer’s stock price.)  Yet, the new guidelines have become instantly controversial, with prominent cardiologists calling them into doubt.  In addition to the substantive scientific dispute, there are also questions about whether the guidelines panel may have suffered from biases, due to conflicting interests.  As PharmaLot reports:

Of the 15 panelists that authored these new guidelines, six reported having recent or current ties to drugmakers that already sell or are developing cholesterol medications. And among the half dozen who disclosed these relationships was one of the two panel co-chairs, which contradicts an Institute of Medicine suggestion about managing conflicts on such panels.  Each of the six panelists disclosed they worked as a consultant and received funding for personal research. And among the 10 expert reviewers, half listed consulting relationships.

I, of course, do not know the right answer about statins on the merits.  As a layperson, I must use proxies and heuristics to decide, and to some extent busy non-specialist physicians must do the same.  That is the whole point of the guidelines — so that each individual physician does not have to review the science himself or herself.  They are supposed to be able to simply rely on the guidelines, as the state of the art.  Yet, the conflicts of interests undermine our confidence in the AHA/ACC guidelines, making them less impactful on our prior beliefs.  (My own research has documented this sort of discounting, among both physicians and laypersons).  That sort of discounting is perfectly rational.

Some have argued that it is unrealistic to find experts who do not suffer from such conflicting interests.  But what if the AHA/ACC had just proceeded with the nine unconflicted panelists, and the five unconflicted reviewers?  Regardless of whether the panel reached the same outcome, it might have then better served the bona fide interests of the AHA and ACC, as well as the interests of public health.  If that panel did reach the same pro-statin outcome, which boosted Pfizer’s stock price, all the better.

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