Tuesday, October 09, 2007

CT Scans to Screen for Lung Cancer, Tobacco Companies, CT Scan Manufacturers, and the NIH

The Wall Street Journal just reported about conflicts of interest affecting a study of chest CT scans to screen for lung cancer financed by the National Institutes of Health (NIH).

On one hand, two of the study's investigators turn out to have had recent financial ties to the tobacco industry. "University of California Los Angeles radiologist Denise Aberle, one of the study's two national leaders" was revealed to have

testified for the American Tobacco Co., now part of Reynolds American Inc., that
'it is reckless or irresponsible to promote' CT screening. Court transcripts in the Louisiana case show that Dr. Aberle's role as co-leader of the government study was highlighted repeatedly. American Tobacco lawyer Gary Long says that what made Dr. Aberle a good witness was 'the fact she could talk about the national lung cancer screening trial that is ongoing.'

Also, "Dartmouth College radiologist William Black, the principal investigator at one of the 30 study sites in the country" was revealed to have

provided an expert report for Philip Morris USA, a unit of Altria Group Inc., in which he warned that CT screening 'may do more harm than good.'

On the other hand, the group that brought up the issue, "the Lung Cancer Alliance, a Washington, D.C., nonprofit that supports screening," turns out to be "funded by individual donations and corporate grants, including $100,000 from General Electric Co...." General Electric makes CT scanners.

On GoozNews, Merrill Goozner posted some pithy comments about the case. To quote Goozner,

Rival industrial interests are funding researchers and patient advocacy groups who square off over the utility of a wildly expensive technology of questionable benefit, and NIH turns a blind eye to how conflicts of interest might undermine its much-needed objective study of the issue. This is a classic example of everything that ails the health care technology assessment field, made more graphic by the presence of the tobacco industry, everybody's favorite whipping boy and for good reason.

The result was,

The expenditure of $200 million in taxpayer money should have resulted in a definitive answer. Now all we'll get is endless bickering over the meaning of the results by self-interested parties whose first line of attack will be the financial ties of the researchers or advocates on the other side.

His suggested solutions?

Congress should create a new institute to test new technologies and compare them to existing technologies.... The new agency must scrupulously avoid all conflicts of interest, with industrial interests kept as far as possible away from the decisions of what to study, how to design the trials, and how to interpret the results. And, the researchers who conduct the studies must follow a simple rule: You can't have had any financial conflict of interest within the past five years to participate in such a study.


NIH must end its laissez-faire attitude toward monitoring the conflicts of interest of the extramural researchers based at the nation's universities, who absorb 80 percent of its annual $30 billion budget. Universities have proven that they ... aren't up to the task of monitoring their professors. Indeed, the commercialization imperative that now dominates thinking at most major universities (they earn revenue from licensing the patents that come from NIH-funded research) has created a structural conflict of interest that has blinded them to improprieties....

Just so.

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