Are conflict of interest statements worth it? Do the end readers dig deeper and find inconsistencies in the “practise guidelines”? How do we decide the merit of each individual patient when faced with a clinical scenario?
This paper is interesting:
- BACKGROUND: The producers of clinical practice guidelines (CPGs) may not disclose industry funding in their CPGs. We reviewed Canadian national CPGs to examine the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members and organizational procedures for managing financial conflicts of interest.
- METHODS: For this descriptive study, we searched the asset map of the Strategy for Patient-Oriented Research Evidence Alliance and the CPG Infobase for CPGs published between Jan. 1, 2016, and Nov. 30, 2018.
- None of the 3 government-sponsored organizations reported industry funding, and none of their committee members disclosed financial conflicts of interest.
- Among the 18 disease or condition interest groups and medical professional societies, 14 (93%) of the 15 that disclosed funding sources on websites (3 did not disclose) reported organizational funding from industry, but none disclosed this information in the CPGs; 12 (86%) of the 14 with conflict-of-interest disclosure statements in the CPG (4 did not include disclosures) had at least 1 committee member with a financial conflict (mean proportion of committee members with a conflict 56%); and for all 8 CPGs with identifiable chairs or cochairs (chairs or cochairs not reported for 10) at least 1 of these people had a financial conflict of interest.
- None of the guidelines described a plan to manage organizational financial conflicts of interest.
- INTERPRETATION: Canadian CPGs are vulnerable to industry influence through funding of producers of guidelines and through the financial conflicts of interest of committee members.
- The CPG producers that receive industry funding should disclose organizational financial conflicts in the CPGs, should engage independent oversight committees and should restrict voting on recommendations to guideline panelists who have no financial conflicts.
- Industry sponsorship of research and investigators’ financial conflicts of interest are associated with reporting favourable results, drawing conclusions that overstate positive effects, and understating or ignoring harms.9–19 Physicians who interact with the pharmaceutical industry and its representatives write more prescriptions and prescribe more expensive drugs than those who do not have such interactions.20,21 The development of CPGs requires careful assessment of the benefits and harms of care options, which involves interpreting evidence and making value-based judgments.22–25 In this context, there is a risk that the financial conflicts of interest of committee members may influence recommendations.1–7,22–35 This risk may be exacerbated if organizations that produce CPGs depend on industry funding to support their activities.2,33–35
- Recommendations published in 2011 by the US Institute of Medicine (now known as the National Academy of Medicine) emphasized that funders should not have any role in CPG development, but they did not specify whether CPG producers should accept industry funding for CPG development, nor did they address the disclosure and management of financial conflicts of interest of the CPG producer.23 The principles of the Guidelines International Network (GIN) address the management of financial conflicts of interest of CPG committee members but not the financial conflicts of the organizations that oversee CPG production.22
- We aimed to determine the proportion of Canadian national CPGs published since 2016 with recommendations related to medications that disclosed industry-related organizational funding, either in the CPGs themselves or at organizational websites; the proportion of guidelines with financial conflicts of interest that were disclosed in the CPGs; the proportion of CPG committee members with financial conflicts of interest; and whether organizational procedures for managing financial conflicts of interest were described in the CPGs.
- We chose this starting date, 5 years after publication of the Institute of Medicine recommendations,23 because these were the first influential recommendations to address management of financial conflicts of interest in CPGs, and we believed that 5 years provided sufficient time for their dissemination and integration into CPGs. We chose a descriptive design that included evaluation of CPGs and of the websites of producer organizations, so that we could compare information on industry associations that was reported in CPGs with external information available elsewhere for most organizations.
- Clinical practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” 36 We classified CPGs as national if they were intended for use across Canada and were not created and intended for use in regional or provincial populations only.
- One investigator (K.E.) searched for CPGs published between Jan. 1, 2016, and Nov. 30, 2018, using the asset map of the Strategy for Patient-Oriented Research Evidence Alliance38 and the CPG Infobase.
- The searches were initially conducted on Nov. 30, 2018, with an additional prepublication search on Feb. 9, 2020, to ensure that we did not miss eligible CPGs from the study period that might have subsequently been added to the CPG Infobase.
A high proportion of committee members who develop CPGs produced by disease or condition interest groups and medical professional societies also have industry-related financial conflicts of interest. We did not find any examples where these organizations stated that they restricted committee membership or participation on the basis of industry-related financial conflicts of interest.
How do you trust these recommendations, then?