Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study

Abstract

Clinical practice guidelines (CPGs) support clinical decision-making and health care practice standards and are among the most-cited articles in medical journals. There is recognition of the need to develop CPGs that are free of commercial influences. [1][2][3][4][5][6][7][8] 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][10][11][12][13][14][15][16][17][18][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 valuebased judgments. [22][23][24][25] In this context, there is a risk that the financial conflicts of interest of committee members may influence recommendations. [1][2][3][4][5][6][7][22][23][24][25][26][27][28][29][30][31][32][33][34][35] This risk may be exacerbated if organizations that produce CPGs depend on industry funding to support their activities. 2,[33][34][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,

Sunshine on KOL : a retrospective study about financial ties between medical key opinion leaders and pharmaceutical industry in France

“…Major ties between leaders of professional medical associations and the pharmaceutical industry have recently been described in North America. 10,11 In France, these links had never been studied yet.…”

“…Recommendations for clinical practice, which define the diagnostic criteria and treatment of the diseases, can also be under influence, since their authors often have ties with the industry. [6][7][8][9][10][11] Following the example of the USA with the US Physician Payments Sunshine Act, France created the Transparency in Healthcare public database (transparence.santé.gouv.fr) in 2014. [12][13][14] Pharmaceutical and medical device industries are required by law to disclose gifts, agreements and remunerations they transfer to healthcare professionals in France.…”

Managing conflicts of interest in the development of health guidelines

“…When an organization developing a guideline depends on industry funding and produces guidelines related to products from industry partners, the oversight committee would ideally be extra-organizational. 43…”

“…44 Because industry funding is common among Canadian guideline producers, more work will be required on how to ensure that these COIs are appropriately disclosed and managed. 43,45 Patient involvement in guidelines, particularly if patient partners receive funding to advocate for their condition, must also be considered. In addition to the potential future expansion of the GIN principles, journal editorial requirements and tools for evaluating guidelines [46][47][48] could both play a role in addressing these gaps.…”

Is ‘conflict of interest’ a Misnomer? Managing interests in immunization research and evaluation

“…16 Given the subtle ways in which clinical care and prescribing can be affected, it is perhaps surprising that organizational interests are not declared in Canadian clinical practice guidelines. 17 Even individual investigators working at seemingly independent institutions are subject to competing interests driven by their own motivations for career benefit or fame which have, in some extreme but welldocumented cases, led them to produce fraudulent data for publication. 18 More subtle and perhaps more frequent is the support offered to resource-constrained public health decision-makers and clinicians by better-resourced industry representatives, which can result in industry becoming the main source of information or knowledge translation.…”