Many treatment guidelines are written by experts with financial conflicts

Physicians typically rely on treatment guidelines issued by medical associations, but a new study finds that many experts involved in assembling these guidelines in Canada have financial ties to drug makers. And the study authors recommend that medical societies implement tougher disclosure rules to avoid undermining clinical decisions.

Conflict of interest management depends on the existence of a critical culture that recognises the issues. Waldo Jaquith

Conflict of interest management depends on the existence of a critical culture that recognises the issues. Waldo Jaquith, The Conversation

By Ed Silverman, STAT August 22, 2016

The researchers analyzed 350 authors who worked on 28 different treatment guidelines, some of whom actually worked on multiple documents. Altogether, they examined 400 financial conflicts of interest statements in connection with the guidelines published in 2012 and 2013, but found that relationships with drug makers varied, according to the analysis, which was published last week in BioMed Central.

In 75 percent of the disclosures, at least one guideline author revealed such a relationship and in 21 percent of the guidelines, all of the authors disclosed a conflict with drug companies. More specifically, in 54 percent of the guidelines, at least one author revealed a conflict with the manufacturer of the drug they recommended for treatment. And in 29 percent of the guidelines, more than one of the authors did so.

The findings follow years of concern about the extent to which individual experts and their ties to drug makers may influence crucial treatment guidelines. The issue was famously debated three years ago when new guidelines were issued for prescribing statins to treat high cholesterol, but gained attention two decades ago, when a government panel was assembled to create a cutoff for determining obesity.

Other studies, in fact, have attempted to discern conflicts. For instance, a 2009 study found that 18 of 20 – or 90 percent – of the authors of guidelines for treating schizophrenia and depression held conflicts with drug makers, but did not disclose these ties. And a 2011 study of cardiovascular treatment guidelines found that 277 of 498 – or 56 percent – of the authors reported a financial conflict.

“Our findings support the need for future research to measure not only the prevalence, but also underreporting of (conflicts) in guidelines,” the researchers wrote. “Our results also suggest a need for accurate and consistent disclosures. Future research is also necessary to determine whether guideline authors’ reported (conflicts) are associated with their drug treatment guideline recommendations.”

For the record, the researchers defined a financial conflict of interest as financial compensation, as well as activities that are generally associated with gifts, payments, or reimbursements, even if a monetary value was not disclosed.

There’s more, by the way.

The latest analysis noted that eight of the guidelines listed affiliated organizations that held financial relationships with drug companies whose medicines were recommended. Specifically, 19 of 39 organizations — or 49 percent — revealed financial relationships with companies on their web sites. And in 26 percent of the guidelines, at least one drug recommended for first-line treatment was manufactured by a drug company listed on the affiliated organization web site.

Another nugget: The researchers also found that 28 of the 48 author declarations on two or three guidelines were consistent in their disclosure statements, but that 20 declarations revealed different conflicts in their disclosure statements in two or three guidelines. In short, there was inconsistent reporting, although it’s possible that disclosure policies differ or financial relationships changed.



Reporting of financial conflicts of interest in clinical practice guidelines: a case study analysis of guidelines from the Canadian Medical Association Infobase, Adrienne Shnier, Joel Lexchin, Mirna Romero and Kevin Brown. BMC Health Services Research, 201616:383 Published 15 August 2016 DOI: 10.1186/s12913-016-1646-5


Orthopaedic surgeons and the medical device industry: the threat to scientific integrity and the public trust, Gelberman RH, Samson D, Mirza SK, Callaghan JJ, Pellegrini VD Jr. J Bone Joint Surg Am. 2010 Mar;92(3):765-77. doi: 10.2106/JBJS.I.01164.

Conflicts of interest and disclosure in the American Psychiatric Association’s Clinical Practice Guidelines, Cosgrove L, Bursztajn HJ, Krimsky S, Anaya M, Walker J. Psychother Psychosom. 2009;78(4):228-32. doi: 10.1159/000214444. Epub 2009 Apr 28.

Conflicts of interest in cardiovascular clinical practice guidelines, Mendelson TB, Meltzer M, Campbell EG, Caplan AL, Kirkpatrick JN. Arch Intern Med. 2011 Mar 28;171(6):577-84. doi: 10.1001/archinternmed.2011.96. PMID: 21444849.

Also see
Are Financial Conflicts of Interest in Medical Research Overblown? New Republic
Don’t show me the money: the dangers of non-financial conflicts The Conversation
Med schools are ignoring conflict-of-interest problems MacLean’s
In medical research, financial conflicts of interest do matter The Boston Globe
FDA issues new draft guidelines for ‘appearance’ of conflicts of interest STAT

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