“Caught between the critics who say NICE is being ‘ridiculous’ for not listening to the experts, and those that say we are being overly influenced by those with a vested interest…” The words of Prof. Gillian Leng, Deputy Chief Executive at the National Institute for Health and Care Excellence (NICE). Prof. Leng was discussing the difficulty of ensuring an objective and transparent approach to the work of NICE in a blog for the British Medical Journal.
In July, NICE announced they were seeking feedback on their new conflicts of interest policy document, and last week they closed this consultation period. The importance of transparency and collaboration is something very close to the collective hearts of the team at Aurora, which is why I am proud to have submitted comments to NICE on this policy. It was very important to us that we shared our position, which is one of both transparency and collaboration.
The well-documented problems in health systems across the world will not be solved through more distanced and fragmented working. If we document potential conflicts of interest and are able to have grown up conversations about them and the importance of collaboration, we can get on with the job at hand, improving patient outcomes.
Transparency between the pharmaceutical industry and those involved with it continues to be an important topic in healthcare. This is absolutely the correct approach, we must ensure interactions are appropriately recorded and publicised, as this will help to demonstrate that what is often perceived as a conflict of interest is not an inherent negative. Rather it may be a demonstration of joined up thinking.
Looking at how experts are consulted on NICE panels, it is understandable why people may perceive a conflict of interest. However, this really serves to demonstrate a lack of understanding of the drug development process and the practicalities of working with experts. True experts need to be involved in the clinical development and trials of new treatments as they often run the tertiary care centres. They should also be involved in the assessment of the cost-effectiveness of a treatment, as their expertise indicates they truly understand the evidence.
The very nature of these experts means that there are only a few of them who are truly able to provide the level of judgment needed, just because they received payment through this process for their time, does not mean that they are now beholden to the writers of the cheque. They are precisely the right people to be involved, based on their experience. There is a clear need to educate the public as to this process and the importance of collaboration throughout it – so we can ensure we are making correct judgments about new medical innovations.
A concerning element of this debate, often not discussed, is the lack of transparency of those who publish books and do media appearances based on a position or opinion. Often vocal commentators will have book sales which are enhanced by well-publicised views that surely make it difficult for them to change their thoughts against their previously stated opinions. This is as much of a conflict of interest as receiving payment from a commercial organisation as an expert.
We all should absolutely be sceptical, and we should question, but at the same time, there should be no shame in collaboration. We all have an inherent bias and as such we all have conflicts of interest, in everything we do. They are not necessarily bad or guaranteed to cloud our thinking, however, we must be aware of all conflicts, not just financial payments or professional work, but also our outwardly stated opinions be they published or simply on social media. And, we should remember the quote in the title by the inspirational Helen Keller, “Alone we can do so little; together we can do so much.”
If you would like to have a chat about our collaborative work, whatever challenges you are facing, please do get in touch.