June 21, 2013

More Criticism of the AACE Diabetes Algorithms

The American Association of Clinical Endocrinologists apparently likes to pick and chose its fights. They did not attack Anne L. Peters, MD, CDE, Professor of Clinical Medicine; Director, Clinical Diabetes Programs, Keck School of Medicine, University of Southern California, Los Angeles, California. Yet, they pulled out all stops to clash with Jerry Avorn, MD, Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital.

Therefore, I would be inclined to believe Dr. Avorn struck a raw nerve in his criticism of AACE's business ethics and they could not let that go without a denial for posturing position. Dr. Avorn stated in his New York Times op-ed piece, “The A.A.C.E.’s latest guidelines elevate many second- or third-line drugs to more prominent positions in the prescribing hierarchy, rivaling once uncontested go-to medications like metformin, an inexpensive generic. They also emphasize the riskiness of established treatments like insulin and glipizide, which now carry yellow warning.”

This is something to consider and I missed this point in my discussion here. Dr. Avorn also states in his New York Times op-ed piece, “But there is also concern that they could have been influenced by another factor: the manufacturers of some of these new drugs financially supported the development of the guidelines, and many of the authors are paid consultants to some of those companies.” I agree, as there was too little information published with the AACE Diabetes Algorithms and nothing stating how they were developed and if others had approved them. When something is just published with little additional information except some press and quotes from a Dr. Garber, criticism should be expected.

When you know that they have many corporate-partners in the pharmaceutical ranks, the denial of what Dr. Avorn says holds no water and clearly is done to appease the corporate ranks. Review the corporate-partners list here. If you carefully read this denial on the AACE website, they only deny corporate funding of the algorithms, but make no denial of the consulting fees paid by corporate-partners. There may have been a healthy bonus in their consulting pay. How else could these “experts” have, “Donated days of time and talent to accomplish what they value as an important component of public health.”

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