Industry “Rewrites” of NCCN Guidelines

Robert W. Carlson
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The uses and distribution of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) continue to increase dramatically, with more than 3 million downloads from the NCCN Web site in 2010 alone. More than 230,000 individuals in 194 countries are registered users of the NCCN Web site. Some of the major drivers of this increase in use are the expertise of the panel members, the high quality and transparency of the NCCN Guidelines development process, the associated drug compendium, and the free availability of the guidelines. The quality and availability of the NCCN Guidelines have made them the major reference for cancer care professionals in guiding the actual care of patients with cancer in the United States. Studies have shown that concordance with guideline recommendations improves the quality and lowers the cost of cancer care.

The impact of the NCCN Guidelines recommendations for anticancer therapy on the market is substantial because of physician choice, patient request, and payor coverage decisions. The diagnostic, device, and pharmaceutical industries often quote the NCCN Guidelines in marketing materials as they attempt to increase sales of their products. When done accurately, this should ideally improve the appropriateness and quality of provided care. There is substantial risk, however, that the guidelines will be used in misleading or incomplete ways in marketing efforts. Recently, a diagnostic company misrepresented a recommendation from the NCCN Guidelines for Breast Cancer in a letter to physicians, on the company Web site, and, reportedly, verbally through its sales staff to physicians. These efforts appear aimed at increasing the use of the company's product through a company “rewrite” of the NCCN Guidelines recommendation. How should the medical community respond to this type of misleading marketing effort?

We all need to understand the pervasiveness of conflicts of interest, especially financial, that exists in contemporary American medicine. We should very cautiously read and interpret recommendations made or communicated by individuals, organizations, or companies who may benefit financially from guideline recommendations. This is especially true of industry marketing efforts that are directly and specifically aimed at increasing the use of a product, and that often provide only a partial discussion of the evidence, a biased perspective on the data, or a misleading or false interpretation of the data or guideline recommendation. There is no substitute for accessing the actual NCCN Guidelines to confirm statements made regarding recommendations. We might just be surprised at how often the NCCN Guidelines are rewritten (or at least misrepresented) by third parties.

The ideas and viewpoints expressed in this commentary are those of the author and do not necessarily represent any policy, position, or program of the NCCN.

Robert W. Carlson, MD, is Professor of Medicine in the Division of Oncology and Stanford Medical Informatics at Stanford University Medical Center.

Dr. Carlson received his medical degree from Stanford University Medical School and completed his internship and junior residency in internal medicine at Barnes Hospital Group in St. Louis. He returned to Stanford for his senior residency and postdoctoral fellowship in medical oncology. Dr. Carlson is board certified in internal medicine and holds subspecialty certification in medical oncology.

Dr. Carlson is a member of several medical societies. He also lectures extensively and has authored or co-authored over 130 articles, abstracts, and book chapters. He is also Associate Editor of Oncology and JNCCN. Dr. Carlson serves as chair of the NCCN Breast Cancer Panel and several NCCN Task Forces. He is also a member of the NCCN Breast Cancer Risk Reduction Panel, Breast Cancer Disease-Specific Executive Committee, CME Advisory Committee, Guidelines Steering Committee, and Board of Directors.

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