When your doctor is looking to make a diagnosis or choose a treatment, she often checks to see what the experts recommend.
Guidelines from these groups of leading doctors help the average physician decide if it's time to prescribe drugs to lower a patient's cholesterol or turn to medicines for someone's depression.
But how solid are the recommendations? There's reason to wonder. An analysis just published by PLOS Medicine finds the majority of experts involved in 16 recently published guidelines had ties to industry. Most of the recommendations expanded the definitions of common illnesses, lowering the threshold for treatment.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders --DSM-5, for instance, essentially drops bereavement as an extenuating circumstance for feelings that might otherwise be labeled depression. Psychiatrist Allen Frances called "the decision to confuse normal grief with clinical depression" one of the worst made by the experts who worked on the revised manual.
"Making grief a mental disorder will be a bonanza for drug companies, but a disaster for grievers," Frances wrote.
All told, the analysis of work by 16 expert groups finds that 10 changes widened definitions of illness and only one (for anemia related to kidney disease) narrowed the scope for diagnosis and treatment. In the five remaining cases, the effect of the changes was unclear.
The financial ties included such things as consulting gigs, speaking fees and research funding.
The group led by Ray Moynihan, of Australia's Bond University, concedes that it didn't evaluate the merits of the changes. "However, findings that diagnostic thresholds are being lowered by panels dominated by those with financial ties to multiple companies that may benefit directly from those decisions raise questions about current processes of disease definition," the authors conclude.