CMAJ • February 8, 2011; 183 (2). doi:10.1503/cmaj.111-2009





Bones and groans

Alban C. Goddard Hill, BSc MD

Belleville, Ont.

As a general practitioner to whom patients presumably look for a source of disinterested information about their health, I have difficulty knowing what to make of the latest recommendations in the osteoporosis clinical practice guidelines1 and accompanying commentary.2 Contained therein is an expanded list of indications for testing and drug treatment for osteoporosis as recommendedby a group of 13 Canadian academics, bolstered by an endorsement from an international expert.


The now standard list of competing interests in those articles reveals that of the 13 academics, 10 list a total of 131 pharmaceutical corporate sponsors (an average of 13 each). The author of the supporting commentary lists 47 national divisions of 32 pharmaceutical corporate sponsors, in addition to the European Federation of Pharmaceutical Industries and Associations.


If nothing else, this revelation suggests that, as bone density goes down, medical profits go up. But are patients receiving good value for their investment? We continue to look forward to an independent cost–benefit analysis as our publicly funded health system groans under the collective weight of screening orthodoxy. Perhaps the three independent academics on the panel could be invited to write a minority opinion.


Presumably it is only a matter of time until governments add osteoporosis screening to the list of conditions for which general practitioners are paid search-and-destroy screening incentive bonuses — at which point we will all stop asking questions and instead be content that the public is being well served through the continuing wholesale adoption of pharmaceutical industry guidelines.




Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864–73.[Free Full Text] Kanis JA. New osteoporosis guidelines for Canada. CMAJ 2010;182:1829–30.[Free Full Text]



Letter to the editor 16 February 2010
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A.C. Goddard Hill,
Belleville, Ont.

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It is informative to see the Uniform Format for Disclosure of Competing Interests in ICMJE Journals (CMAJ October 27, 2009) translated into action in the Review of Management of Asthma in Adults (CMAJ, December 8, 2009) by Balter,Bell, Kaplan, Kim and McIvor. To look at the stunning list of competing interests listed at the end of the article by the authors is to invite the obvious next question, which is exactly how much money did these authors receive from the corporations listed? (As we now know from a recent American case, apparently the sky is the limit.) All of these individuals seem to be obliged to multiple drug companies which in turn realize huge profits by selling essential (we are told) drugs at extortionate prices to patients who cannot (we are told) do without them and often cannot afford them. Even the Canadian Thoracic Society is enjoying the corporate largesse, and there is nary an independent academic view in sight in the article. And we are supposed to believe this stuff? What exactly is it again that CMAJ editors do these days?


A. C. Goddard Hill, B Sc, MD, CCFP

General and Family Physician

Competing interests: none


Conflict of Interest:

None declared



Re: Re: Response to Goddard Hill   


Feb 22,    2010




I thank Drs. Balter, Nehrlich, O'Donnell and Boulet for their responses to my letter. I pondered these responses as I wrote another $120 steroid inhaler prescription for a patient with the common syndrome of asthma, no drug plan, and no money.


In my opinion, guidelines for the management of a medical condition which are written by persons who are on the payroll of a drug company or companies should be regarded as drug industry guidelines. Such guidelines should be viewed with perspicacity. Indeed the purpose of the international medical journal policy of publishing a list of authors' competing interests is a sort of caveat emptor.


Lamentably, however, these industrial guidelines are now being published by our own national medical journal presumably because there is a dearth of independent information available from academic centres.


Exactly where this will lead us is a matter of speculation.


Sincerely yours,

A. C. Goddard Hill, B.Sc, MD, CCFP;

30 year Member, Canadian Medical Association;

Belleville, Ontario


Conflict of Interest:

None declared