NICE should be independently investigated in relation to its systems designed to deal with conflicts of interest of its Guideline Development Group Pan
We write to you as the Chair of the Health Select Committee to seek the Committee’s views on what we believe are serious shortcomings in the National Institute of Health and Care Excellence’s evaluation processes, which has resulted in the recommendation to offer statin medications to those at low risk of cardiovascular disease. We have particular concerns in relation to the management of conflicts of interest of the Guideline Development Group panels, and apparent systemic weaknesses which the Institute appears to have no appetite to address. We are concerned that the system of recruitment, appointment and the monitoring of conflicts of interest of Panels is not fit for purpose.
We feel that Professor David Haslam has failed to adequately address crucial points from a letter previously written by a number of us on the subject of the medicalisation of 5 million healthy individuals, potential conflicts of interest, industry bias, hidden data and loss of professional confidence. Professor Haslam’s letter is attached.
The medicalisation of 5 million healthy individuals
Professor Haslam mentions that “the [NICE] independent guideline group has carefully considered benefits and harms (of statins) in a systematic way with modelling to explore areas of uncertainty” and that the group was able to reach the conclusion that the “benefits outweigh the harms and that statins are clinically and cost effective for people with a CV risk of 10% or over”.
He says that the “potential sizeable increase in the number of people who might take statins as a result of this guidance [that] the potential costs to the NHS may be lower than in 2012 due to a reduction in their price”
However, a paper published in the BMJ which underwent further analysis – both groups being independent of industry conflicts, concludes that statins do not reduce overall mortality or serious illness in those with a 10% risk of CVD.
1 We therefore find it unhelpful that NICE’s director of clinical practice, Professor Mark Baker uses such emotive language when describing the benefits of statins,
conflating the effects of heart disease as a condition which “kills, maims and destroys lives” in the same context as prescribing statins to those at low risk. In our view, this could be perceived as scaremongering and persuading people to take statins when the evidence does not clearly support this statement. The public might expect better from NICE.
Potential conflicts of interests
He states that he is “very concerned that (NICE) guidance should carry the support of the professions” but appears to have not acknowledged the views of representative organisations of UK Doctors –namely the British Medical Association and the Conference of Local Medical Committees, both in terms of grave concerns in regards to access to the raw data and perhaps more importantly conflicts of interest within NICE’s guideline development groups.