Integrity in Science reports the National Kidney Foundation (NKF) has refused to disclose the membership of its expert panel that convened to re-evaluate its anemia guidelines for individuals with end-stage renal disease. Studies, including one published in the New England Journal of Medicine, have found that NKF-approved treatment levels of an anti-anemia drug, erythropoietin, in kidney disease patients results in more incidents of heart problems and deaths.
The existing NKF anemia guidelines were were underwritten by Amgen, Inc., one of the main manufacturers of the anti-anemia drug. According to the Integrity in Science report, 11 of the 16 members of the NKF’s expert panel had ties to the companies that manufacture and sell the anti-anemia drug.
The Wall Street Journal reported that the New England Journal of Medicine had spiked a “Perspective” article by its national correspondent, Robert Steinbrook, who had analyzed the increase in deaths from overuse of the Epoetin anti-anemia drug. Steinbrook’s article—which was also critical of the NKF guidelines and the conflict of interest of the expert panel—eventually ran in the Lancet. Steinbrook reported that NKF receives 57 percent of its annual budget from corporate sponsors, including the anti-anemia drug manufacturers (US$4.1 million from Amgen, Inc. and US$3.6 million from a Johnson & Johnson division in 2005, both of which sell erythropoietin).
Integrity in Science provides more evidence of the NKF conflict of interest:
“In an article in the current issue of the Clinical Journal of the American Society of Nephrology, Daniel W. Coyne of Washington University School of Medicine in St. Louis blasted the committee’s decision last year to ignore unpublished data showing excess mortality even though the NKF was aware of the results. ‘In whose interest was it not to delay release of the guidelines until the results of these studies were available,’ he asked. In a written response, five physicians from the committee, four with ties to the drug makers, said reviewing only published studies ‘served as a safeguard against bias.’”
Coyne also called for the prohibition of physicians with conflicts of interest from serving on the NKF guideline-writing panels. “There are many physicians in academia with few or no ties to industry who are well trained to evaluate evidence from clinical trials and capable of writing guidelines,” Coyne told Integrity in Science. “By not restricting corporate conflicts of interest among guideline panel members, the NKF has sometimes chosen physicians clearly favored by their sponsoring corporations, and effectively encourages those companies to attempt to influence all panel members.”
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