Monday, May 22, 2006

New Dispute Over Industry Involvement with a New Definition of Hypertension: "Monetarization of Medicine?"

Almost a year ago we discussed a dispute that had broken out within the American Society of Hypertension (ASH) about the role of industry in and conflicts of interesting affecting the society's work.

The New York Times has followed-up with another story, this one highlighting the society's role in a new and more expansive definition of hypertension. This definition included some people with "pre-hypertension," previously defined as a blood pressure between 120/80 and 139/89, within a newly defined "state 1 hypertension" group. This expanded definition appeared in an article whose lead author was the current President of ASH (Giles GD, Berk BC, Black HR, Cohn JN, Kostis JB, Izzo JL Jr, Weber MA. Expanding the definition and classification of hypertension. J Clin Hypertens 2005; 7: 505-512.) The Times noted that "of the seven doctors who wrote the proposed new definition, six have said they served as consultants and speakers for pharmaceutical companies that make blood pressure medications. The seventh is a consultant and stockholder in a company that markets a diagnostic method to measure damage to blood vessels."

The Times also noted "the work of the group that developed it was financed by $75,000 in unrestricted drug industry grants from Merck, Novartis and Sankyo...." Furthermore, a society staffer "confirmed that the dinners [to discuss the new guidelines] were financed by $700,000 in grants, also unrestricted, from the same companies."

Internal critics within the society criticized the process. "This is about the monetarization of medicine," said former society President Dr Michael H Alderman, who had withdrawn from the group which proposed the new hypertension definitions. Furthemore, he noted, "all this has got the ring of seeming to be of great benefit to the pharmaceutical industry without clear evidence that it's going to be the same benefit to the public." Dr Curt D Furberg, from Wake Forest University, also withdrew from the group. He charged that "its work was not evidence-based, ... [and] 'the industry wants to sell drugs and to as many people as possible.'" Jane E Sealey, who had been President-Elect of the society, said, "the truth of the matter is that we have many members who are leaders in our society who are making well into the six figures from their pharmaceutical-company-supported activities." Dr Sealey immediately resigned her presidency at the society's annual meeting, according to

ASH President Giles countered that "the organization had always maintained a firewall between its activities and industry funding. 'We don't take money that has strings attached to it.'" One of the authors of the new hypertension definition, Dr Joseph L Izzo of the University of Buffalo, said "there are those who accuse us of being nothing more than shills of industry: a lot of us take pretty great offense at that."

This seems to be another example of how disease definitions get expanded, often with some degree of participation by pharmaceutical companies who have interests in increasing the market for their products. Note also that the sorts of possible conflicts of interest described may have largely unconscious effects on those affected, as we have discussed. So the indignation of people who are not conscious "shills of industry" is real, but perhaps misplaced.

Furthermore, this is another case that suggests physicians and patients need to be increasingly skeptical about the apparently authoritative guidelines that now rain down on us.

Finally, the Times also reported that Dr Steven E Nissen, new president of the American College of Cardiology, "suggested that the medical profession had become addicted to industry money just as the nation was addicted to foreign oil." Maybe it's time to kick the habit.

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