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Conflicts of interest prevalent among clinical practice guideline producers
Mendelson T. Arch Intern Med. 2011;171:577-584.
Nissen S. Arch Intern Med. 2011;171:584-585.
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Although a significant portion of professionals do not have conflicts of interest, a prevalence of conflicts of interest among the writers and creators of CV clinical practice guidelines exists, new study results suggested.
Researchers of the Archives of Internal Medicine study examined disclosure lists from the 17 most recent American College of Cardiology/American Heart Association clinical guidelines through 2008.
The researchers reported 651 episodes of participation in guideline preparation and creation by 498 individuals. Of those, 277 individuals (56%) reported a conflict of interest, and 365 of the 651 episodes of guideline preparation involved a conflict of interest of some kind. The most common conflict reported was that of receiving consult fees/presence on an advisory board, followed in order by receiving research grants and then receiving honoraria/presence on a speaker’s bureau. The researchers also reported an association between episodes in which at least one conflict was reported and individual guidelines (P<.001). Conflicted episodes occurred most frequently with the ACC/AHA Guidelines for the Management of Patients with STEMI and the 2007 ACC/AHA Guidelines for the Management of Patients with Unstable Angina/NSTEMI (29 each) and with chronic HF (27).
“Although restricting participation may present some qualified individuals from serving in the guidelines production process, we found that a large percentage of individuals with guidelines experience reported no disclosures, suggesting there is a substantial pool of potential guideline writers and reviewers without conflicts of interest,” the researchers wrote.
In an accompanying editorial, Steven Nissen, MD, of the Cleveland Clinic Foundation in Ohio and a member of the Cardiology Today Editorial Board, called the number and extent of the financial relationships with industry among clinical practice guideline writers “extraordinary.”
“The revelations reported in the current article highlight troubling concerns that must be urgently addressed,” Nissen wrote. “If we fail as a profession to police our clinical practice guideline process, the credibility of evidence-based medicine will suffer irreparable harm.”
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