Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.

<h4>Background</h4>Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed...

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Autores principales:	Raymond N Moynihan, Georga P E Cooke, Jenny A Doust, Lisa Bero, Suzanne Hill, Paul P Glasziou
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/a18e0bf327f54093896fb080b54dac94
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spelling	oai:doaj.org-article:a18e0bf327f54093896fb080b54dac942021-11-18T05:43:10ZExpanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.1549-12771549-167610.1371/journal.pmed.1001500https://doaj.org/article/a18e0bf327f54093896fb080b54dac942013-08-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23966841/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties.<h4>Methods and findings</h4>We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating "pre-disease"; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications.<h4>Conclusions</h4>For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies. Please see later in the article for the Editors' Summary.Raymond N MoynihanGeorga P E CookeJenny A DoustLisa BeroSuzanne HillPaul P GlasziouPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 10, Iss 8, p e1001500 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Raymond N Moynihan Georga P E Cooke Jenny A Doust Lisa Bero Suzanne Hill Paul P Glasziou Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.
description	<h4>Background</h4>Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties.<h4>Methods and findings</h4>We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating "pre-disease"; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications.<h4>Conclusions</h4>For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies. Please see later in the article for the Editors' Summary.
format	article
author	Raymond N Moynihan Georga P E Cooke Jenny A Doust Lisa Bero Suzanne Hill Paul P Glasziou
author_facet	Raymond N Moynihan Georga P E Cooke Jenny A Doust Lisa Bero Suzanne Hill Paul P Glasziou
author_sort	Raymond N Moynihan
title	Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.
title_short	Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.
title_full	Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.
title_fullStr	Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.
title_full_unstemmed	Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.
title_sort	expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the united states.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/a18e0bf327f54093896fb080b54dac94
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Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States.

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