Bones and groans

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 recommended by 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.