Abstract
BackgroundThere is an emerging literature on the existence and effect of industry relationships on physician and researcher behavior. Much less is known, however, about the effects of these relationships and other conflicts of interest (COI) on clinical practice guideline (CPG) development and recommendations. We performed a systematic review of the prevalence of COI and its effect on CPG recommendations.Methodology/Principal FindingsWe searched Medline (1980 to March, 2011) for studies that examined the effect of COI on CPG development and/or recommendations. Data synthesis was qualitative. Twelve studies fulfilled inclusion criteria; 9 were conducted in the US. All studies reported on financial relationships of CPG authors with the pharmaceutical industry; 1 study also examined relationships with diagnostic testing and insurance companies. The majority of guidelines had authors with industry affiliations, including consultancies (authors with relationship, range 6–80%); research support (4–78%); equity/stock ownership (2–17%); or any COI (56–87%). Four studies reported multiple types of financial interactions for individual authors (number of types per author: range 2 to 10 or more). Data on the effect of COI on CPG recommendations were confined to case studies wherein authors with specific financial ties appeared to benefit from the related CPG recommendations. In a single study, few authors believed that their relationships influenced their recommendations. No studies reported on intellectual COI in CPGs.Conclusions/SignificanceThere are limited data describing the high prevalence of COI among CPG authors, and only case studies of the effect of COI on CPG recommendations. Further research is needed to explore this potential source of bias.
Highlights
Since the emergence of the concept of evidence-based medicine [1], healthcare providers have sought ways to synthesize evidence into formats and products that are both valid and readily implemented into routine practice
According to the Institute of Medicine (IOM) 2008 report entitled Knowing What Works in Healthcare [2]: ‘‘Decisions about the care of individual patients should be based on the conscientious, explicit, and judicious use of the current best evidence on the effectiveness of clinical services.’’ Clinical practice guidelines (CPGs) are an important tool for achieving optimal patient care, and the recently updated definition of clinical practice guideline (CPG) is ‘‘statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options’’ [3]
There are few studies describing financial conflicts of interest (COI) for CPG authors and the available data suggest that there is a high prevalence of nondisclosure of COI among authors across a variety of clinical specialties, and a high percentage of CPG authors with disclosures report COI
Summary
Since the emergence of the concept of evidence-based medicine [1], healthcare providers have sought ways to synthesize evidence into formats and products that are both valid and readily implemented into routine practice. According to the Institute of Medicine (IOM) 2008 report entitled Knowing What Works in Healthcare [2]: ‘‘Decisions about the care of individual patients should be based on the conscientious, explicit, and judicious use of the current best evidence on the effectiveness of clinical services.’’ Clinical practice guidelines (CPGs) are an important tool for achieving optimal patient care, and the recently updated definition of CPGs is ‘‘statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options’’ [3]. About the effects of these relationships and other conflicts of interest (COI) on clinical practice guideline (CPG) development and recommendations. We performed a systematic review of the prevalence of COI and its effect on CPG recommendations
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