Evaluation of Conflicts of Interest among Participants of the Japanese Nephrology Clinical Practice Guideline

Abstract

Background and objectivesRigorous and transparent management strategies for conflicts of interest and clinical practice guidelines with the best available evidence are necessary for the development of nephrology guidelines. However, there was no study assessing financial and nonfinancial conflicts of interest, quality of evidence underlying the Japanese guidelines for CKD, and conflict of interest policies for guideline development.Design, setting, participants, & measurementsThis cross-sectional study examined financial and nonfinancial conflicts of interest among all 142 authors of CKD guidelines issued by the Japanese Society of Nephrology using a personal payment database from all 92 major Japanese pharmaceutical companies between 2016 and 2019 and self-citations by guideline authors. Also, the quality of evidence and strength of recommendations underlying the guidelines and conflicts of interest policies of Japanese, US, and European nephrology societies were evaluated.ResultsAmong 142 authors, 125 authors (88%) received $6,742,889 in personal payments from 56 pharmaceutical companies between 2016 and 2019. Four-year combined median payment per author was $8258 (interquartile range, $2230‒$51,617). The amounts of payments and proportion of guideline authors with payments remained stable during and after guideline development. The chairperson, vice chairperson, and group leaders received higher personal payments than other guideline authors. Of 861 references in the guidelines, 69 (8%) references were self-cited by the guideline authors, and 76% of the recommendations were on the basis of low or very low quality of evidence. There were no fully rigorous and transparent conflicts of interest policies for nephrology guideline authors in the United States, Europe, and Japan.ConclusionsMost of the Japanese CKD guideline recommendations were on the basis of low quality of evidence by the guideline authors tied with pharmaceutical companies, suggesting the need for better financial conflicts of interest management.

Pharmaceutical money to Japanese board-certified dermatologists: A four-year retrospective analysis of personal payments from pharmaceutical companies between 2016 and 2019

“…The Gini index ranges from 0 to1, and the greater the Gini index, the greater the disparity in the distribution of payments on the specialist basis. 11 Additionally, the trends in annual personal payments to dermatologists were examined by population-averaged generalized estimating equation (GEE) models with panel-data of payments clustering each dermatologist between 2016 and 2019. 5,6 The log-linked linear GEE model with Poisson distribution for the number of dermatologists receiving payments and negative binomial regression GEE model for the per-dermatologist payments were applied, as the payments were highly skewed.…”

“…3 Due to this payment disclosure, we previously reported there were substantial and prevalent nancial relationships between pharmaceutical companies and physicians in several specialties including oncology, hematology, pediatrics, infectious diseases, and pulmonology in Japan. [4][5][6][7][8] These personal payments were often made to physicians in authoritative and in uential positions such as clinical practice guideline authors, 6,[9][10][11][12] society board members, 6,13 university professors, 6,8,14 and television expert commentators. 15 We also found that there was a pattern in recipient of personal payments by factors such as gender and regions.…”

Evaluation of financial relationships between Japanese certified pediatric hematologist/oncologists and pharmaceutical companies: a cross‐sectional analysis of personal payments from pharmaceutical companies between 2016 and 2019

“…Demographic data concerning physician gender, affiliations, positions in their affiliations, participation in clinical practice guidelines for pediatric cancers, and participation in the society board membership were collected from the official webpage of their affiliation and the JSPHO. All PHOs authoring clinical practice guidelines issued by the JSPHO between 2015 and 2020 (one year before and after the study period) were identified from the JSPHO webpage, as clinical practice guideline authors often received payments from companies before, during, and a few years after guideline publication 17,19–21 ; disclosure of these payments were strongly recommended by many societies 22–24 . As the name list of the JSPHO board member between 2016 and 2020 was not available, the PHOs who positioned in the JSPHO board member as of March 2022 were considered.…”

“…were identified from the JSPHO webpage, as clinical practice guideline authors often received payments from companies before, during, and a few years after guideline publication 17,[19][20][21] ; disclosure of these payments were strongly recommended by many societies. [22][23][24] As the name list of the JSPHO board member between 2016 and 2020 was not available, the PHOs who positioned in the JSPHO board member as of March 2022 were considered.…”

Conflicts of Interest and the Trustworthiness of Clinical Practice Guidelines

“…One might hope that academics engaged in the creation of guidelines are able to put these relationships and payments out of their minds in making their judgments. However, the magnitude of the monetary payments identified by Murayama et al (4) reflects important and likely enduring connections, and the knowledgeable and informed individuals useful to a clinical practice guideline committee are identical to industry’s perception of key opinion leaders (5). A systematic review of clinical practice guideline recommendations identified an association (relative risk, 1.3; 95% confidence interval, 0.9 to 1.7) between financial conflicts of interest and decisions favorable to those interests (7).…”