Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis

Abstract

ObjectiveTo assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies.MethodsSurvey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards.ResultsThe survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed.ConclusionsThe finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy.

Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review

“…89% of disclosures in World Health Organization (WHO) guidelines [14]), or scant (11% in the US National Guideline Clearinghouse [15]). Yet, disclosure of COIs is only feasible if organisations have policies or mechanisms in place to require or facilitate them; however, it appears that over a third lack them entirely [16]. Nearly all professional societies receive financial support from industry and have industry-sponsored events during their scientific meetings.…”

Parsing the guidelines on guidelines: Balancing sensibility and conflict of interest

“…To mitigate this hazard, a number of organizations, including the Institute of Medicine (IOM), the Guidelines International Network, and the Appraisal of Guidelines, Research and Evaluation (AGREE) Collaboration have issued (what else but) guidelines for the proper appraisal of medical literature, and for the appropriate management of conflicts of interest (COI) of members of the committees charged with implementing and summarizing recommendations. While these publications have focused attention and provided important guidance on this serious issue, it also has spawned a sizeable literature decrying the failure of writing groups and societies to fully comply with procedural and COI recommendations . Unfortunately, the American Association for the Study of Liver Diseases (AASLD) recently found itself ensnared by one of these investigative studies.…”

“…While these publications have focused attention and provided important guidance on this serious issue, it also has spawned a sizeable literature decrying the failure of writing groups and societies to fully comply with procedural and COI recommendations. (6)(7)(8)(9) Unfortunately, the American Association for the Study of Liver Diseases (AASLD) recently found itself ensnared by one of these investigative studies.…”

Conflict of interest disclosure: striking a balance?

“…CoI have become a hotly debated concept in the scientific literature during the last few decades in medicine too [4]. Although many definitions have been proposed [5], the core of the first one-issued by Thompson in [6] and adopted by the WHO [7]-is still the most cited. Accordingly, CoI are 'a set of conditions in which professional judgment concerning a primary interest tends to be unduly influenced by a secondary interest'.…”

“…CoI are potentially ubiquitous in medicine [12], virtually affecting all aspects. They have been analyzed for biomedical [13] and clinical [14] research, medical education [15] and patient fundraising [16], publications in scientific journals [17,18], health care [5] and clinical [19] guidelines.…”