Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review

Abstract

Objective: To systematically evaluate the prevalence of disclosed and undisclosed financial conflicts of interest (FCOI) among clinical practice guidelines (CPGs). Methods: In this systematic review, we ascertained the prevalence and types of FCOI for CPGs from January 1, 1980, to March 3, 2019. The primary outcome was the prevalence of FCOI among authors of CPGs. FCOI disclosures were compared between medical subspecialties and societies producing CPGs. Results: Among the 37 studies including 14,764 total guideline authors, 45% had at least one FCOI. The prevalence of FCOI per study ranged from 6% to 100%. More authors had FCOI involving general payments (39%) compared with research payments (29%). Oncology, neurology, and gastroenterology had the highest prevalence of FCOI compared with other medical specialties. Among the 8 studies that included the monetary values in US dollars of FCOI, average payments per author ranged from $578 to $242,300. Among the 10 studies that included data on undisclosed FCOI, 32% of authors had undisclosed industry payments. Conclusion: There are numerous FCOI among authors of CPGs, many of which are undisclosed. Our study found a significant difference in FCOI prevalence based on types of FCOI and CPG sponsor society. Additional research is required to quantify the implications of FCOI on clinical judgment and patient care.

A Cross-Sectional Examination of Conflict-of-Interest Disclosures of Physician-Authors Publishing in High-Impact US Medical Journals

“…1,2 Physician researchers who receive industry payments are more likely to demonstrate results favorable to the companies funding them; 3,4 are more likely to prescribe drugs and use of medical devices produced by these companies, from statins 5 to opioids 6 to endoscopic 7 and orthopedic devices; 8 and they may unduly influence other physicians by contributing to research that others use to guide their own clinical practice. [9][10][11][12][13][14][15][16] Industry payments to physicians therefore may bias healthcare providers' delivery of evidence-based medicine and interfere with their responsibilities to their patients.…”

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“…Reconocer el cuidado nutricional como un derecho humano establece un compromiso, con una responsabilidad ética muy importante, que debe basarse en el res-peto de los 4 principios éticos (autonomía, beneficencia, no maleficencia y justicia) (43) , así como en otros principios, como la vulnerabilidad, la igualdad, la justicia y la equidad (44) . Asimismo, siguiendo el concepto de justicia distributiva, los cuidados nutricionales se deben proporcionar de forma equitativa a todos los individuos desnutridos o en riesgo de desnutrición, pero no iguales en el sentido de que, dependiendo de diversos factores, por ejemplo, regionales, culturales, entre otros, estos pueden variar, logrando objetivos similares.…”

“…En menos del 30 % de las GPC formuladas en China se cuenta con la declaración de CDI (41) ; en cambio, solo 1 de 45 GPC disponible en el Ministerio de Salud danés cuenta con esta declaración, y el CDI más frecuente es participar como consultor o empleado de compañías farmacéuticas o de dispositivos médicos (41,42) . En la más reciente revisión sistemática sobre CDI en la formulación de GPC se describe que el 45 % de los autores tiene al menos un CDI derivado de pagos directos o como financiamientos de investigación, y el 32 % no los declara (43) .…”

Centralised Full Access to Clinical Study Data Can Support Unbiased Guideline Development, Continuing Medical Education, and Patient Information

“…Although the quality of clinical practice guidelines has improved, deficits still exist [ 23–27 ]. Besides a limited evidence base and a lack of methodological stringency, guidelines are commonly affected by (often undisclosed) conflicts of interest (COI) of guideline authors, which tend to be associated with biased recommendations [ 28 , 29 ]. An extreme example of the potential consequences of such recommendations is their role as a potential contributing factor to the opioid epidemic in the USA.…”