CMS Endorses Hiding Conflicts of Interest from Public

Last Friday, the Center for Medicare and Medicaid Services adopted a policy that makes a mockery of the concept of conflict of interest disclosure and will only serve to further obscure how the pharmaceutical industry is skewing the practice of medicine.

Last Friday, CMS announced it will begin allowing oncologists to refer to the National Comprehensive Cancer Network's guidelines and drug-use compendium when they seek reimbursement for the off-label use of anti-cancer drugs. The Center for Science in the Public Interest, in a belated public comment, had protested inclusion of the NCCN compendium because it does not disclose the individual conflicts of interest of physicians who write its guidelines.

To see the full CMS decision, you can go here. The relevant paragraph on the conflict of interest issue reads:

It incorporates a process for public identification and notification of potential conflicts of interest of the compendia's parent and sibling organizations, reviewers, and committee members, with an established procedure to manage recognized conflicts. The policy . . . (has) public disclosure the listing of all potential conflicts of interest and full disclosure of every organization that has provided funding to NCCN on their website. Member dues pay staff and operating costs, while industry grants pay distribution costs.

In fact, the compendium does not publicly disclose potential conflicts of interest as such disclosures are routinely made in the medical and scientific literature. Therefore, what CMS has posted on its website is a deliberate obfuscation.

As I pointed out here, the NCCN compendium does not list the conflicts of interest of individuals on its publicly available guidelines. It only lists all the companies that gave money or research grants to ANY of the physicians who served on the committee. The individual ties between specific companies and specific physicians are not revealed. This is the same strategy used by the American Society of Clinical Oncologists, which represents the nation's 20,000 oncologists, to hide conflicts of interest during its annual meeting, which just concluded in Chicago.

This policy turns disclosure on its head and renders it meaningless. It deliberately hides from the public, patients and practicing physicians the individual financial ties that oncology's thought leaders have to pharmaceutical firms. Congress should investigate whether it wants the decision to spend Medicare tax dollars driven by such a transparently non-transparent process.