The ink has barely dried on the Iona Heath independent panel report into the demands from Rory Collins that two papers, which dared to reference another peer-reviewed paper that mentioned statins having side effects, be retracted. Heath’s panel very sensibly concluded that the papers should not be withdrawn and the panel admonished Collins for trying to buck the open and transparent BMJ system for handling such issues.
Collins complained about the articles by email to Fiona Godlee, editor of the BMJ, at the end of October 2013. He insisted on a private meeting, which was held in December 2013. Collins was asked by Godlee to express his concerns in a rapid response to the BMJ or an article – as is the normal process for open debate on matters of wide importance. Collins never did this. Instead he continued to try to use private channels to censor that which he did not want published.
The new stunt
On September 18th I received an email forwarded from a doctor specialising in heart disease.
From: [email protected]
Date: Thu, 18 Sep 2014 10:46:50 +0100
Subject: BCS Statins Survey<
IMPORTANT: STATIN SURVEY
The British Cardiovascular Society is keen to know of any potential adverse effect on cardiovascular disease prevention which may have resulted from recent media stories and articles such as those published in the BMJ (1,2) and in an open letter to NICE (3).
We would be grateful if members would complete this short survey. Your response will be anonymous and the link below is unique to you allowing you to complete the survey once only.
The survey closes on 30th September and results will be made available subsequently on the BCS Website and in the BCS newswire.
(1) Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ 2013; DOI:10.1136/bmj.f6123.
(2) Malhotra A. Saturated fat is not the major issue. BMJ 2013; DOI:10.1136/bmj.f6340
PLEASE CLICK HERE TO COMPLETE THE SURVEY
The two papers referenced just happen to be the ones that Collins didn’t like. The ones that he wanted removed from the BMJ altogether. Having failed, a society that you have probably never heard of, The British Cardiovascular Society, is trying to stir up trouble to smear the authors of these papers and the letter to NICE.
The end in mind
This is not an open and genuine survey – honestly interested in evidence based medicine. This is a loaded and leading survey with a clear end in mind. The British Cardiovascular Society (BCS) are not interested in any positive outcomes from the publicity surrounding Collins vs. The BMJ. They are not interested in Mrs Jones, who decided to come off statins, having heard about the side effects, who now finds that she can walk again. They don’t care about Mr Smith whose libido may have come back – along with his mind, mood and memory. They are only interested in adverse effects and anecdotes about adverse effects.
As Dr Malcolm Kendrick explained here: “Now, why would they be doing this? I do not think it is that difficult to work it out. The BCS is trying to gather evidence that the articles by Abramson, Malhotra and the open letter to NICE have caused harm to patients. They will be asking their members if they know of people who have stopped taking statins, or who will not go on statins, because of what they have read in the BMJ and suchlike.
Once they have done this, they will then extrapolate the raw figures to the entire population of the UK, in order to claim that ‘Thousands have died.’ Abramson will be attacked, along with Malhotra and the BMJ. I will get a few attacks as well for drafting the letter to NICE. This is a very unsubtle variation of the ‘You’re killing my patients’ tactic which is regularly used to silence any who dares criticise currently medical opinion.”
Who are the British Cardiovascular Society?
The May 2013 annual report tells us that “The British Cardiovascular Society is dedicated to the promotion of cardiovascular health.” (Download from this page).
The web site thanks its main partner: “The British Cardiovascular Society (BCS) is grateful to the generous support of its Industry Partner, Bayer PLC.” I bet it is.
The office address is 9 Fitzroy Square, London, W1T 5HW. Remember this.
I emailed BCS on September 24 to ask:
On your web site you share that “The British Cardiovascular Society (BCS) is grateful to the generous support of its Industry Partner, Bayer PLC.”
Please can you help with the following:
– Do any other pharmaceutical companies provide funding, directly or indirectly to the BCS?
– How much does Bayer donate?
I have had no response.
A web of conflict
I started to look at the “Officers of the Society” for individual conflicts of interest and I started to recognise some names from previous conflicts of interest research. What emerged was a glimpse into a web of conflict involving a large number of self created organisations/charities, in the field of heart disease, with connections to and funding from pharmaceutical companies. I suspect that I have barely scratched the surface.
There are individual organisations, such as the BCS and/or Heart UK (the ultimate voice piece of the statin industry) and then a representative from each of them meet together as a body called the Joint British Societies. The president of BCS, Iain Simpson, is a member of the Joint British Societies (JBS). He declares no conflicts of interest at JBS. His thought process must go something like – I’m at JBS representing BCS and so I don’t have to declare the fact that BCS is funded by Bayer? No, that doesn’t work for me either.
The Joint British Societies
The representatives from other organisations, which form the JBS, are as follows. Where Declarations Of Interest (DOI) have been made, they derive from this document, which is dated March 2014. Where declarations have not been made, I have searched for them and referenced the source:
Prof John Deanfield Represents the British Heart Foundation and claims “No DOI”, despite the fact that the BHF is in bed with Flora margarine.
Dr Susan Connolly Declares “Travel grant and advisory board for Merck Sharp Dohm”.
Prof Patrick Doherty Represents BACPR – the British Association for Cardiovascular Prevention & Rehabilitation. Despite being supported by the BHF (Flora) and being “an affiliated group of the BCS” (Bayer), Doherty declared “no DOI.” The address for the BACPR is also 9 Fitzroy Square, London, W1T 5HW.
Prof Keith Fox Declares funding from: “British Heart Foundation; Medical Research Council; Wellcome Trust” and “Additional Grant Funding and honoraria: Sanofi Aventis, Lilly, Bayer/Janssen, Astra Zeneca, GSK.”
Prof Richard Hobbs Declares consultation and speaking engagements with BI, Bayer, BMS/Pfizer, Medtronic all in non-prevention of CVD areas.
Prof Aroon Hingorani Declares that he is on the advisory board for Roche.
Prof Steve Jackson Co-representing the British Hypertension Society, one of the British Cardiovascular Society affiliates. Jackson declared “no DOI.” Really? Daiichi-Sankyo, Boston Scientific and Omron Healthcare are friends of the society.
Dr Catriona Jennings Represents another of the British Cardiovascular Society affiliates: British Association for Nursing in Cardiovascular Care (BANCC). She is President of this society, which also has 9 Fitzroy Square as its address. She states “No DOI.” Pfizer and Astra Zeneca are declared here, however.
Prof John Potter Declares that he has served on the Advisory Boards of several Pharma companies including Merck Sharp Dohm and Bayer, from whom he has received honoraria.
Prof Naveed Sattar Has consulted for: Amgen, Sanofi, Astrazeneca, BMS, Roche, UCB and Boehringer Ingelheim. Speaker Bureau for Lilly, Merck Sharp Dohm.
Dr Fran Sivers Has worked with Unilever on HeartAge and has advised a Medical Charity called Dipex.
Prof David Spiegelhalter Claimed no DOI. Yet on his own web page he states “I have acted as a paid statistical consultant to a variety of organisations, including the Healthcare Commission, World Anti-Doping Agency, Novartis, and GlaxoSmithKline.”
Prof Gerard Stansby Claimed no DOI. This page clarifies “GS has received research funding and fees for speaking and chairing meetings from a number of pharmaceutical companies.”
Dr Paul Stevens Claimed “No DOI”. In CG182 here, Appendix D has the declarations of interest for this NICE development group. Stevens are listed as “Honoraria for lectures and attendance at international meetings for Ortho Biotech, Bayer, Amgen, Pfizer and Hoffman La Roche and a research grant from Roche UK for developing an expert system for the management of chronic kidney disease.”
Prof Peter Weissberg Represents the British Heart Foundation and claims “No DOI.” Not even Flora?
Dr David Wheeler Declared consultancy Fee/Honoraria from: Amgen, Janssen, Astellas, Baxter, Merck Sharp Dohm, Vifor Pharma, Otsuka, Fresenius, Shire Research grants: Genzyme, AstraZeneca.
Prof Bryan Williams Claimed “No DOI.” He’s Chair of Medicine at the Institute of Cardiovascular Sciences. Can you imagine that being free from pharma funding? Here’s a throw away comment on his bio page “He holds grant awards from the NIHR, MRC and the BHF as well as collaborative grants with industry.”
Dr Peter Winocour Served on clinical expert advisory boards supported by Novo Nordisk, BI, Sanofi Aventis, Merck Sharp Dohm, and received support to attend meetings from Novo Nordisk and BI.
Prof David Wood Declared honoraria for Advisory Boards (Merck, Sharp & Dohme) and invited lectures (including AstraZeneca) Unrestricted research grants to the European Society of Cardiology from several pharmaceutical companies (AstraZeneca, Bristol-Myers Squibb/ Emea Sarl, GlaxoSmithKline, F. Hoffman-La Roche, and Merck, Sharp & Dohme).
There are two more members, whom we will come to shortly.
The position of the JBS
The Joint British Societies – when declarations are fully made – reads like a pretty comprehensive representation of the statin making pharmaceutical industry. Sure enough, this is the Joint British Societies view on Lipid lowering therapy:
* Intensive statin therapy is recommended in all patients following MI, in the absence of a contraindication or intolerance, irrespective of initial cholesterol values.
* Statins should be prescribed with a ‘lower is better’ approach to achieve values of at least <2.5mmol/L for non-HDL-c (equivalent to <1.8mmol/L for LDL-c).
At the end of this article, the Competing interests are declared as follows: “There are no significant competing interests.”
Did you spot the address for correspondence for the Heart journal? Yes – Heart is the publication of the British Cardiovascular Society, 9 Fitzroy Square, London, W1T 5HW.
The Connection to the NICE statin guidelines.
My newsletter back in February 2014 shared that the Guideline Development Group (GDG) had serious conflicts of interests, which should have led to the exclusion of 8 out of 12 panel members from the group. NICE showed that it really couldn’t care less about this and went ahead with their ‘everyone should be on statins‘ advice.
Two of the members of the Joint British Societies were on the NICE statin GDG:
Alan Rees as a member of the JBS declared “Advisory Board and talks for: Aegerion, AstraZeneca, Merck Sharp Dohm, Sanofi-Aventis, Pfizer, BMS and Novo Nordisk.”
Dermot Neely declared that he was representing Heart UK and that he had “No DOI”. This whole DOI thing is getting beyond a joke. These are the partners of Heart UK – how are these not conflicts of interest? The declaration for the NICE GDG also included “In the past 12 months I have participated in one-off advisory boards for pharmaceutical companies developing lipids modifying therapy for specialist use in poorly treatment responsive and/or severe inherited lipids disorders, including Roche Pharma (dalcetrapib), Genzyme (mipomersen), and Aegerion (lomitapide).” Not relevant?
What started as research into the British Cardiovascular Society, for a leading and loaded survey, with a clear and underhand end in mind, ended up as a discovery of a web of organisations, charities and affiliates with pharmaceutical funding, shared addresses and what seems to be an extensive network of statin pushers.
I can think of two reasons:
1) It gives the appearance of a number of ‘respectable’ organisations/charities all believing in the same thing. In this case that “Intensive statin therapy” should be enforced with a “‘lower is better’ approach.”
2) It creates a ‘once removed’ structure, so that the pretty much universally conflicted members of the Joint British Societies group seem to think that it’s OK that they put their names to a “lower is better” policy as members of the JBS and then ‘forget’ that they are funded by the companies who will benefit from this exact policy.
Conflict is conflict. I often say that liver is the most nutritious food on the planet, because that’s what nutrient analysis shows. If I received any funding whatsoever from a liver association/organisation/producer – you should know about it. And it should not matter which meeting I am attending one day or the next – the liver conflict would prevail and should always be declared. Given my abhorrence towards conflicts of interest you won’t be surprised to know that I have received no such payments from any organisation and never will I sell my soul in this way. It’s just disgraceful that this position is not shared by people in positions of power and influence.