They led influential medical groups, starred at prestigious meetings, published in top journals and were undisputed giants in their field.

But when these famous doctors advised the government recently on new cholesterol guidelines for the public, something else they had in common wasn’t revealed.

Eight of the nine were making money from the very companies whose cholesterol-lowering drugs they were urging upon millions more Americans. Two own stock in them. Two others went to work for drug companies shortly after working on the guidelines. Another was a senior government scientist who moonlights for 10 companies and even serves on one of their boards.

Consumer groups and others now are questioning not only the advice these doctors gave but also their fundamental ability to act in the public’s best interest.

It comes as some of these companies lobby the government to let drugs at the center of this controversy - statins such as Lipitor and Zocor - be sold over the counter. Prominent doctors with ties to statin makers are urging approval.

There’s little doubt that statins save lives or that too few people take them now. But critics say the doctors’ coziness with drug companies compromises their credibility and undercuts their latest advice that more people would benefit from these medications.

Conflicts of interest are increasingly common now that two-thirds of medical research at universities is funded by private industry. Twenty years ago, only one-third was.

Many people think that big corporations have too much power, but “we have to live in the context of the country’s structure,’’ said Dr. Scott Grundy, a Texas cardiologist who headed the cholesterol panel. “The government is not producing drugs. All the big statin trials have been paid for by the companies.’‘

Government has its own problems. A ban on private consulting was lifted a decade ago, and recent years have seen one scandal after another involving federal scientists taking money from companies directly affected by their decisions.

Conflicts also have bedeviled trusted groups like the American Heart Association, which rely on private cash for meetings and activities, and the continuing medical education system, which often gives doctors credits for attending drug-company-sponsored talks that sometimes amount to paid commercials.

The drug industry spent $2 billion in 2001 on events for doctors - double what it spent five years earlier, Dr. Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine, reports in his new book, “On the Take.’‘

“The time has come to ask whether all of the money floating around medicine has created a pattern of corruption,’’ he writes. “Clinical advice, like votes, should never be bought.’‘

Some say it’s naive to think a panel of true experts with no industry ties could be assembled today.

Christopher Seymour, executive director of the National Lipid Association, a group that promotes cholesterol control and is largely funded by drug companies, has six of the nine guideline panel members on his board.

“Who in America is going to write these guidelines if you don’t go to the thought leaders? Should I call Dr. X in the middle of Peoria? What gives them credentials to be on my board?’’ he asked.

But at the University of Illinois in Peoria, they think quite a lot of Dr. Frank Gold, who in 30 years as a cardiologist has managed not to take consulting or lecture fees from industry.

“I’m squeaky-clean,’’ he says, and “would jump at the opportunity’’ to serve on a guidelines panel. “There are tons of people like me, and they’re even in places like Des Moines, Iowa.’‘

The statin flap reveals much about modern medicine and how industry influences decisions that affect the health of ordinary Americans.

It involves drugs with so much science behind them and proven benefits that doctors only partly joke about putting them in the water supply.

More than half of American adults have High cholesterol, raising their risk of heart attack. Doctors tell them to eat right and exercise, but that takes time to work and usually produces only modest improvement. Statins’ ability to drop cholesterol dramatically and almost overnight has made them the nation’s top-selling drugs.

The government’s National Cholesterol Education Program periodically asks experts to help set guidelines for controlling cholesterol. Not surprisingly, rules issued in 2001 advocate aggressively curbing this risk factor and using statins.

New studies prompted officials to convene a new panel to revise the guidelines. Seven of its nine members had been on the previous one. The newcomers - Dr. Sidney C. Smith Jr. of the University of North Carolina in Chapel Hill and Dr. C. Noel Bairey Merz of Cedars-Sinai Medical Center in Los Angeles - were representatives of the heart association and the American College of Cardiology, respectively.

These groups in July endorsed and published the new guidelines, which set cholesterol limits even lower, encouraging statins for millions more Americans.

A day later, the Center for Science in the Public Interest said the advice was tainted by doctors’ industry ties, which weren’t disclosed.

The financial ties ranged from long-ago grants to a doctor’s university to do research all the way up to stock ownership and ongoing deals providing thousands of dollars in personal income from statin makers.

The most complicated situation is that of Dr. H. Bryan Brewer, chief of the molecular disease branch of the National Heart, Lung and Blood Institute, which houses the federal cholesterol program.

He is on the scientific advisory board of Lipid Sciences Inc., a private biotechnology firm developing cholesterol treatments, and the National Lipid Association, the industry-backed group that promotes cholesterol control.

Brewer also is a consultant or speaker for 10 companies, including several statin makers. He even attended a meeting in July 2003 of a federal Food and Drug Administration advisory committee debating whether to recommend approval of Crestor, a statin made by AstraZeneca - one of the companies for whom he moonlights.

The meeting was on a Thursday, and it couldn’t be determined whether Brewer was there on government time. He refused requests for an interview. In a memo to National Institutes of Health director Dr. Elias Zerhouni, Brewer wrote that he was “only an observer and did not participate’’ in the FDA meeting, which led to the drug’s approval a month later.

Zerhouni had gotten a complaint from Public Citizen’s Dr. Sidney Wolfe, who said Brewer had inaccurately analyzed Crestor’s risks in a medical journal article whose publishing costs were paid by AstraZeneca.

What is conflict of interest today? Many think they know it when they see it but have trouble defining its boundaries, especially as times change and things once taboo become accepted as industry foots more of the research bill.

“It is very much a continuum. I don’t think there is a sharp line, and that’s where disclosure becomes so important,’’ said Dr. Michael Goldrich, chairman of the American Medical Association’s council on ethical and judicial affairs.

Consulting fees can range from a couple thousand dollars to $50,000 to $100,000 a year, said Mildred Cho, associate director of Stanford University’s Center for Biomedical Ethics.

“The concern is that when you get into these larger amounts, they’re not just for duties performed,’’ but for using clout to help market a drug, she said.

Some guideline panel members talk candidly about their industry ties. Grundy, a cardiologist at the University of Texas Southwestern Medical Center in Dallas and former Heart Association president, said he makes less than $10,000 a year in speaker fees from various companies and refuses to promote a particular drug in a talk.

Dr. Neil J. Stone of Northwestern University Medical School in Chicago, said he takes speaker fees to replace lost income when a talk forces him to miss work and sometimes donates his fees to universities.

“I have scrupulously avoided owning a share of stock in these companies,’’ he said. “I don’t want anybody to think I knew something ahead of time.’‘

Smith, also a former heart association president, said he owns about $10,000 in stock in two companies with heart products, including Johnson & Johnson, which has partnered with Merck & Co. to sell a statin over the counter in England.

“I didn’t even know I had it till I called the fellow that handles the accounts,’’ Smith said of his stock, adding, “Nobody volunteers time for one of these committees because they think a small amount of stock they may have in a retirement plan is going to benefit.’‘

Bairey Merz, the California cardiologist, listed stock in Johnson & Johnson and seven other companies with heart-related business, plus consulting, lecture or research money from nine, including several statin-makers. She declined to be interviewed but said in a brief written statement that she had not breached any ethics rules.

Grundy, the panel’s leader, said he didn’t know any members owned stock. Although it wouldn’t necessarily disqualify them, “I probably would not allow that,’’ he said.

Efforts to interview three other panel members - Dr. Luther T. Clark of State University of New York Downstate Medical Center in Brooklyn, Dr. Donald B. Hunninghake of the University of Minnesota in Minneapolis, and Dr. Richard C. Pasternak of Massachusetts General and Harvard Medical School in Boston - were unsuccessful. Multiple requests to interview Clark and Pasternak were unreturned by spokespeople; Hunninghake could not be located through the university.

Hunninghake quit before the guidelines were released to become a full-time industry consultant, according to the cholesterol program. Pasternak joined Merck soon after the guidelines came out.

Financial conflicts aren’t the only danger. “Group think’’ can set in when a panel doesn’t include people who can look at the science with different views than cardiologists.

“These folks made their careers on being aggressive on treating risk factors,’’ but internal medicine doctors might feel differently, said Dr. Harlan Krumholz, a Yale University cardiologist and epidemiologist who runs a center for medical outcomes research. He’s been on dozens of guideline groups - not this one - and says he’s “pretty careful’’ about industry ties.

“When you’ve been spending your life trying to prove a hypothesis and you believe in a certain thing, you’re obviously seeing the world through that perspective,’’ Krumholz said.

Indeed, many of the doctors making the case for statins helped establish their effectiveness.

“Most of us did all the original trials of the statins,’’ said Stone of Northwestern.

He had a personal reason - his father was the first in his family to live past 48, dying of heart disease in 1985 at age 68.

“He never got a chance to get a statin,’’ Stone said. “I’m actually stunned that people who know the evidence don’t see the enormous value of this class of drugs.’‘

The only panel member with no financial conflicts - the federal cholesterol program’s coordinator, Dr. James Cleeman - is upset by attacks on the guidelines like the letter signed by 35 scientists and doctors asking NIH to launch an independent review.

“They are science-based,’’ Cleeman said. “The public should have confidence in them. I’m an unconflicted person, and I read the science the same way.’‘

Meanwhile, moves are under way to curb conflict.

-The NIH is revising rules on outside consulting. Zerhouni first said it would be banned only for top scientists but now wants restrictions on all employees for two years. He altered his stance after the Office of Government Ethics said this summer that NIH was so full of conflict that across-the-board rules were needed.

-Pressure is growing on medical journals for more meaningful disclosure of authors’ conflicts - not just fine print naming a company without saying what it makes or does. Kassirer cites a June 2003 editorial describing its author as “having equity interests’’ in a company when in fact he was its president and its product was the subject of the article.

-Vermont, with the support of then-Gov. Howard Dean, himself a physician, passed a law in 2002 requiring doctors to disclose gifts over $25 and listing them on the Internet.

-The heart association and College of Cardiology are about to release an ethics report that will make broad recommendations on physician behavior and patients’ interests, Smith said.

As for the statin mess, “I hope that the focus on a potential conflict of interest does not overshadow the real problem that patients are not receiving care which can prevent heart attack and stroke,’’ Smith said.

Stone agreed: “The science is out there for everybody to see. The one thing that I’m very distressed about is these are evidence-based guidelines ... this is not an opinion report.’‘

All the more shame, Kassirer says, that the authors’ financial deals make their advice appear biased.

“I’m just not sure what to believe,’’ he said. “That’s the issue.’‘

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On the Net:

National Cholesterol Education Program’s guidelines:

http://www.nhlbi.nih.gov/guidelines/cholesterol/