Managing Conflicts Of Interest Research Articles

Managing experts’ conflicts of interest in the EU Joint Clinical Assessment

ObjectiveThis article critically evaluates the European Commission’s 2024 Implementing Regulation (IR) on conflicts of interest (COIs) management for stakeholders in the European Union (EU) Joint Clinical Assessment (JCA), with a focus on individual experts such as clinicians and patient representatives.Key findingsThe IR is the first EU-level framework to assess COIs in the context of health technology assessment (HTA). The regulation requires experts involved in the JCA to submit annual declarations of interest for both financial and non-financial interests and presents a matrix on whether these conflicts should disqualify them from participating in the joint work. We compared the IR to COIs-management approaches from other European national HTA bodies and found that the IR is closely modelled after the French guidelines. Concerns include potential over-representation of experts from a small number of countries, lack of guidance on organisational COIs, and ambiguities in how the size of financial interests are disclosed. Unclear resource allocation for enforcement could also hinder compliance.ConclusionsThe IR marks progress in EU-wide HTA collaboration, but improvements in transparency, expert diversity, and comprehensive COIs management are needed to ensure impartiality in the JCA process.

Financial conflicts of interest among authors of clinical practice guideline for headache disorders in Japan

BackgroundFinancial relationships between clinical guideline authors and pharmaceutical companies introduce conflicts of interest (COI), potentially biasing guideline recommendations. Thus, proper management of COI is paramount for clinical guideline authors. Nevertheless, little is known about COI among neurology clinical guideline authors. This study aimed to evaluate the financial relationships between pharmaceutical companies and authors of Clinical Practice Guideline for Headache Disorders (CPGHD) in Japan.MethodsThis is a retrospective analysis of 2016–2020 personal payments data disclosed by all pharmaceutical companies affiliated with the Japan Pharmaceutical Manufacturers Association. We examined amounts and fraction of personal payments to all 57 CPGHD authors and all neurologists board-certified by the Japanese Society of Neurology. Payment data was descriptively analyzed at individual author level.ResultsAmong 57 CPGHD authors, 56 (98.3%) received personal payments totaling $2.7 million from pharmaceutical companies between 2016 and 2020. Median five-year payments were $89,955 for CPGHD authors, while $521 for board-certified neurologists. The CPGHD chairperson and vice chairperson received substantial payments during the guideline development period. Nevertheless, because of less rigorous and transparent COI policy compared to international standard policies, only 10 authors disclosed their financial relationships with the pharmaceutical companies in the guideline.ConclusionsMore than 98% of CPGHD authors received much higher personal payments from pharmaceutical companies than those to board-certified neurologists during the guideline development period in Japan.

Exploring ethical implications in hospital management: Aligning business objectives with patient care ethics

Hospital management is a complex process that involves balancing operational efficiency, financial sustainability, and patient care. As healthcare institutions operate within commercial frameworks, the intersection of business objectives with patient care ethics becomes a significant concern. Ethical considerations in hospital management include resource allocation, stakeholder relationships, conflicts of interest management, and decision-making processes. Balancing profitability demands with ethical obligations poses challenges for administrators, necessitating a comprehensive understanding of managerial practices. Hospitals must balance business objectives with patient care ethics, ensuring ethical practices in resource allocation, managing relationships with multiple stakeholders, and ensuring patient autonomy, beneficence, nonmaleficence, and justice. As hospitals operate within commercial entities, it is crucial to ensure that profitability does not compromise patient well-being or erode trust in healthcare institutions. Healthcare professionals must be aware of the ethical implications of dual relationships with clients, resource allocation, and other ethical decisions. Collaborating scholars, policymakers, and healthcare practitioners can promote ethical excellence in hospital management, enhance patient care outcomes and advancing healthcare ethics.

Conflicts of Interest in Nutrition: Categorical Thinking and the Stigma of Commercial Collaboration

There is a high level of concern about the possible influence of commercial organizations on food-related research and professional bodies, including regulatory and advisory panels. This has contributed to an increased emphasis on the declaration and management of conflicts of interest (CoI) in the reporting, evaluation, and application of research in nutrition science. However, common perceptions of CoI in nutrition, and procedures for declaring and managing these, often lack intellectual rigor and consistency. This commentary highlights 3 main issues related to CoI in nutrition, particularly the emphasis on industry-related CoI relative to other sources of conflict and bias. 1) Considerations of CoI in nutrition are largely limited to financial or collaborative links to the food industry, disregarding other important sources of influence such as intellectual allegiances or nonindustry financial and professional incentives. 2) Associations with industry incur ad hominem, often punitive stigmatization of individuals and their research, and inappropriate downgrading or exclusion of evidence. This disproportionately affects expertise in the food and agricultural sciences, in which commercial collaborations are widely encouraged. 3) These practices and related approaches to managing CoI are applied without due consideration of the nature of the conflicts and activities involved, the qualifications of individuals, or the availability of other, objective methods and guidance for assessing research quality and risks of bias. Overall, recognition of the nature and range of CoI in nutrition and approaches to their identification and management lack consistency and balance. A singular and strict focus specifically on industry-related CoI may paradoxically exacerbate rather than mitigate imbalance and bias in the field. This commentary outlines the underlying issues and the need for more comprehensive and nuanced approaches to the assessment, reporting, and management of CoI in nutrition.

Cross-sectional analysis of pharmaceutical industry payments to authors of clinical practice guidelines for bipolar disorder and major depressive disorder in Japan

ObjectiveClinical practice guidelines (CPGs) are essential for standardising patient care based on evidence-based medicine. However, the presence of financial conflicts of interest (COIs) among CPG authors can undermine their credibility....

Same evidence different recommendations: a methodological assessment of transatlantic guidelines for the management of valvular heart disease.

To identify methodological variations leading to varied recommendations between the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) valvular heart disease (VHD) Guidelines, and to suggest foundational steps towards standardizing guideline development. An in-depth analysis was conducted to evaluate the methodologies used in developing the Transatlantic Guidelines for managing VHD. The evaluation was benchmarked against the standards proposed by the Institute of Medicine. Substantial discrepancies were noted in the methodologies utilized in development processes, including writing committee composition, evidence evaluation, conflict of interest management, and voting processes. Furthermore, despite their mutual differences, both methodologies also demonstrate notable deviations from the IOM standards in several essential areas, including literature review and evidence grading. These dual variances likely influenced divergent treatment recommendations. For example, the ESC/EACTS recommends transcatheter edge-to-edge repair (TEER) for patients ineligible for mitral valve surgery, while the ACC/AHA recommends TEER based on anatomy, regardless of surgical risk. ESC/EACTS guidelines recommend a mechanical aortic prosthesis for patients under 60, while ACC/AHA guidelines recommend it for patients under 50. Notably, the ACC/AHA and ESC/EACTS guidelines have differing age cut-offs for surgical over transcatheter aortic valve replacement (<65 and <75 years, respectively). Variations in methodologies for developing CPGs have resulted in different treatment recommendations that may significantly impact global practice patterns. Standardization of essential processes is vital to increase the uniformity and credibility of CPGs, ultimately improving healthcare quality, reducing variability and enhancing trust in modern medicine.

Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas.

Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures. A workshop was designed to assess member states' regulatory capacity. A thematic analysis was conducted to analyze regional needs, successes and challenges. Thereafter, the Government Capacity-Building Framework for the prevention and control of NCDs was used to examine findings. The findings were organized in two sets: (i) PAHO/WHO actions to support member states and (ii) key actors' actions to advance regulatory policies. The results show notable regulatory progress across the Region of the Americas. However, progress differs between countries, with opportunities to strengthen measures in most countries, mainly in conflict of interest management. The results identified important actions to strengthen the regulatory capacity of PAHO/WHO member states. To maximize momentum for these actions, timelines must be identified, and political commitment can be boosted by applying human rights-based and food system-wide approaches.

Conflicts of Interest in Radiology Publishing

Lack of disclosure of Conflicts of Interest (COI) in radiology research can undermine trust in medical recommendations and patient care. A recent study found significant discrepancies between disclosed COIs and those listed in the Open Payments Database (OPD). This commentary discusses the importance of transparency in financial and nonfinancial COIs, the implications of undisclosed COIs on research integrity and clinical decision-making, and the challenges and controversies surrounding current disclosure practices. The field of radiology should discuss and update COI management and ethical standards, for more practical accountability in radiology publishing.

The Relationship Between Administrative Impartiality and Conflict of Interest and Its Impact on Reducing Administrative Corruption

This article examines the essential role of impartiality and conflict of interest management in combating administrative corruption, emphasizing the importance of a comprehensive legal framework, independent oversight, and modern technologies. The study highlights the need for clear, comprehensive, and harmonized laws that address all aspects of corruption, with stringent penalties for violations. Ensuring the independence and capability of oversight and judicial institutions is crucial for effective law enforcement, as is the establishment of internal oversight mechanisms to prevent corruption within these bodies. The article underscores the role of education and cultural development, recommending continuous training for government employees and promoting an organizational culture based on transparency and impartiality. Additionally, modern technologies such as information management systems, online reporting platforms, and big data analytics are proposed as tools to enhance transparency and efficiency in the fight against corruption. Public access to financial and performance information through online platforms, alongside anonymous reporting systems, is identified as key to strengthening public oversight. The article stresses the importance of simplifying bureaucratic procedures to reduce complexity, improve operational efficiency, and curb corrupt practices. The study advocates for continuous review and amendment of laws in line with international standards, the provision of political and legal support to oversight bodies, and the creation of inter-institutional coordination to prevent conflicts and ambiguities in law enforcement. By drawing on successful experiences from other countries and adapting them to domestic contexts, the article concludes that these comprehensive strategies can significantly reduce corruption, increase public trust, and improve the efficiency of administrative systems in Iran. Key policy recommendations include strengthening the legal framework, enhancing oversight and judicial institutions, improving transparency, and fostering public participation in monitoring governmental activities.

Identification of Water Crisis Management Policy Indicators in the Country Based on the Interpretive Structural Modeling (ISM) Approach

Objective: The aim of the present research was practical in terms of its objectives and descriptive-survey in terms of its data collection method, utilizing an Interpretive Structural Modeling (ISM) approach. Methodology: The participants of this study were 15 managers, policymakers, and water sector experts, who were purposefully invited to participate in this research. The tool used in this investigation was a closed-response questionnaire in a matrix format. The criterion for expertise at this stage was the respondent's professional legitimacy. Findings: The results of implementing the research model indicate that the most important components of the study include legal and regulatory environment factors, economic environment, cultural environment, conflict of interest management, culture building, participation drivers, trust, political strategies, crisis management necessity, constructive institutional interaction, motivation, communication factors, governmental actions, reform and adaptation, facilitative leadership, decision-making stability, financial support, guarantee of sustainable development, control of marginalization, attention to local capacities, appropriate water pricing, promotion of public monitoring, improvement of agricultural water use efficiency, consumption pattern improvement, and legal support. Conclusion: Therefore, issues such as economy and budgeting, healthcare, welfare and social security, education, energy, environmental damage, foreign policy, and national internal security, as well as threats to occupational and job security, or matters like insufficient access to healthcare services should be examined by the government, the private sector, and the commitment of individuals and companies, or a combination of both.

Management of evidence and conflict of interest in guidelines on early childhood allergy prevention and child nutrition: study protocol of a systematic synthesis of guidelines and explorative network analysis.

With the rising prevalence of allergic diseases in children, prevention of childhood allergies becomes an important public health issue. Recently, a paradigm shift is taking place in the approach to preventing allergies, and clinical practice guidelines (CPG) and food-based dietary guidelines (FBDG) play an important role in providing practitioners with the latest evidence and reliable guidance. However, concern about the methodological quality of the development of FBDGs and CPGs, including limitations in the systematic reviews, lack of transparency and unmanaged conflicts of interest (COI), reduce the trust in these guidelines. We aim to synthesize the available guidance on early childhood allergy prevention (ECAP) through a systematic search for national and international CPGs and FBDGs concerning ECAP and child nutrition (CN) and to assess the quality of the guidelines and management of COI. Additionally, we will analyse the content and the evidence base of the recommendation statements. We aim to quantify the COI in guideline panellists and explore possible associations between COI and recommendations. Through a social network analysis, we expect to elucidate ties between panellists, researchers, institutions, industry and other sponsors. Guidelines are an important tool to inform healthcare practitioners with the newest evidence, but quality and reliability have to be high. This study will help identify potential for further improvement in the development of guidelines and the management of COI. If the social network analysis proves feasible and reveals more information on COI in comparison to disclosed COI from the previous analyses, the methodology can be developed further to identify undisclosed COIs in panelists. This research does not require ethical approval because no human subjects are involved. Results will be published in international peer-reviewed open access journals and via presentations at scientific conferences.

Conflict of Interest Management in Adult Attention-Deficit/Hyperactivity Disorder Clinical Practice Guidelines

Clinical practice guidelines (CPGs) require skilled contributors who may have conflicts of interest (COI) that need to be assessed and managed to minimize possible biased influence. Different organizations have unique COI management policies depending on their available expertise, circumstances, and judgment. To inform the development of the American Professional Society of ADHD and Related Disorders (APSARD) COI management procedures, we reviewed the literature. Because there are no CPGs for adult attention-deficit/hyperactivity disorder (ADHD) in the United States, we reviewed COI management policies of related CPGs with a focus on ADHD. There were many common elements, including matching levels of permitted involvement with type of COI. Examples included withdrawals from industry activities and limitations on participation in discussions, deliberations, and/or voting on specific matters. Due to the complexities of COIs, it is impossible to fully operationalize COI management. Ultimately, management of COIs is determined after review by the co-chairs and steering committee in discussion with the task force member. [ Psychiatr Ann . 2023;53(10):455–460.]

Practice Guidelines Development: The APSARD United States Guidelines for the Diagnosis and Treatment of ADHD in Adults

Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder arising in children that persists in many people for the remainder of their lives. While several diagnostic and treatment guidelines in the United States (US) have been developed for childhood ADHD, no guidelines have been published in the US for adults with ADHD. With the increase of care seeking by adults with ADHD accompanied by increasing ADHD medication prescriptions in the past few years, the American Professional Society for ADHD and Related Disorders Association (APSARD) has recognized the need for diagnostic and treatment guidelines for the US. The development of clinical practice guidelines follows a rigorous scientific process of literature review, conflict of interest management, levels of participation of the working group members, clinical recommendations based on published research, a ranking of the quality of data, and a Delphi process to evaluate the rank order of clinical recommendations with little published research available. The Institute of Medicine (now The National Academy of Medicine) and the American Psychiatric Association have established protocols for each of the aforementioned phases of the manuscript development. This article reviews this process in detail and conveys the complexity of the endeavor. [ Psychiatr Ann . 2023;53(10):449–454.]

Intellectual conflicts of interest among cardiology and pulmonology clinical practice guidelines.

Intellectual conflicts of interest (COI), like financial COI, may threaten the validity and trustworthiness of clinical practice guidelines (CPGs). However, comparatively little is known about intellectual COI in CPGs. This study sought to estimate the prevalence of intellectual COI and corresponding management strategies among cardiology and pulmonology CPGs. We conducted a retrospective document review of CPGs published by cardiology or pulmonology professional societies from the United States, Canada, or Europe from 2018 to 2019 available via the Emergency Care Research Institute, Guidelines International Network, or Medscape databases. We assessed the percentage of authors with an intellectual COI, defined as i) authorship on a study reviewed by the CPG, ii) authorship of a prior editorial related to a CPG recommendation, or iii) authorship of a prior related CPG. Management strategies assessed included use of GRADE methodology, inclusion of a methodologist, and recusals due to intellectual COI. Outcomes were assessed overall and compared between cardiology and pulmonology CPGs. Among the 39 CPGs identified (14 cardiology, 25 pulmonology), there were a total of 737 authors, of whom 473 (64%) had at least one intellectual COI. Among all CPGs, a median of 67% (Interquartile Range 50%-76%) of authors had at least one intellectual COI, and COI was more prevalent among cardiology compared with pulmonology CPGs (84% vs 57%, p<0.001). There was variable use of management strategies among the CPGs, including use of GRADE methodology (64% of CPGs), inclusion of a methodologist (49%), and recusals due to intellectual COI (0%). Intellectual conflicts of interest appear to be highly prevalent and under-reported among cardiology and pulmonology CPGs, which may threaten their validity. Greater attention to and improved management of intellectual COI by CPG-producing organizations is needed.

Perspective: Examining Conflicts of Interest for Professional Service within the 2020 Dietary Guidelines Advisory Committee.

Judgments and integrity uphold professionalism. Failure to manage professional conflicts of interest (COIs) may undermine trust in an individual, practitioner, or institution. This perspective article examines standards for nutrition researchers and practitioners to manage COIs for the Dietary Guidelines for Americans (DGA) process. Thereafter, this article analyzes a study published by Mialon etal. that raised concerns about the expert advisory committee selection process and management of COIs for 20 professionals appointed by the Department of Health and Human Services (HHS) and the USDA, who served on a federal government advisory committee to review evidence for the Dietary Guidelines Advisory Committee (DGAC) 2020 scientific report. The analysis found that Mialon etal. enumerated COIs for each DGAC member with industry, removed from the original context, which prevented readers from assessing the COI risk. Moreover, the USDA ethics office concluded that "the 20 committee members were in full compliance with the federal ethics rules applicable to special government employees." I conclude that Mialon etal. could use institutional mechanisms to encourage the USDA and HHS to strengthen future COI policies and procedures, aligned with the 2022 National Academies of Sciences, Engineering and Medicine report recommendations to improve the DGA 2025 to 2030 process.

SAGES perspective: professional medical associations, commercial interests, and conflicts of interest

Professional medical associations (PMAs) have an essential role in advancing medical care and health. PMAs promote skills training, clinical standards, and other important educational activities. Most often, PMAs are not-for-profit entities that rely upon funding from industry to help cover the costs of these valuable activities. Equally important, innovation and progress in surgery require physician collaboration with industry throughout the product development process. SAGES has opined that, with appropriate Conflict of Interest (COI) disclosure and management processes, PMA educational activities can be both scientifically and ethically sound. SAGES has developed and implemented comprehensive and stringent processes for managing potential COI within the organization, at the annual meeting, and in developing educational offerings. This document reviews the SAGES COI processes and results 2009-2021. Implementation of the SAGES COI disclosure and management processes reduced the reported perceived incidence of bias at the annual meeting from 4.4-6.2% (2008-2010) to 1.2-2.2% (2011-2013). Recent comparison of reported disclosures revealed a rise in number of speakers with financial relationships and an increase in reporting of disclosures in presentations without an associated increase in need for conflict resolution by the COI committee. Despite good overall adherence to COI policies, SAGES was recently cited for non-compliance with ACCME standards related to inclusion of faculty with ownership interest. This experience highlighted the potential for discordance in the interpretation of whether disclosures relate to specific CME content. SAGES COI processes have since been updated to reflect the more stringent 2020 ACCME Standards that exclude speakers and planners with ownership interest from any CME activity. The SAGES experience with disclosure and mitigation of financial relationships highlights the challenges of validating the accuracy of physician disclosures and establishing the relevance of financial relationships to the content of accredited educational activities. SAGES will continue to streamline its COI disclosure process with specific focus on aligning all financial disclosures among the various reporting platforms.

Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines.

Clinical practice guidelines assist healthcare professionals in providing evidence-based care. However, pharmaceutical companies' financial interests often influence guideline content. This study aimed to elucidate the magnitude of financial ties among Japanese gastroenterology guideline authors and the pharmaceutical industry. Using pharmaceutical company disclosed payment data, we evaluated financial conflicts of interest (COI) among Japanese Society of Gastroenterology guideline authors between 2016 and 2021. Additionally, we assessed the evidence quality supporting guideline recommendations and associations with financial COI. Finally, we evaluated author COI management during guideline development against global standards. Overall, 88.2% (231/262) of guideline authors received a median of $12 968 (interquartile range [IQR]: $1839-$70 374) in payments between 2016 and 2019 for lectures, writings, and consulting. Chairpersons received significantly higher payments (median: $86 444 [IQR: $15 455-$165 679]). Notably, 41 (15.6%) authors had undeclared payments exceeding declaration requirements. Low or very low-quality evidence supported 41.0% of recommendations. There was a negative association between the median 4-year payment per author and the proportion of recommendations based on low-quality evidence (odds ratio: 0.966 [95% confidence interval [95% CI]: 0.945-0.987], P=0.002) and positive association with moderate-quality evidence (odds ratio: 1.018 [95% CI: 1.011-1.025], P<0.001). Still, the Japanese Society of Gastroenterology guideline development process remains less transparent, with insufficient COI policies relative to global standards. There were extensive financial COI between pharmaceutical companies and guideline authors, and more than 40% of recommendations were based on low-quality evidence. More rigorous and transparent COI policies for guideline development adhering to global standards are warranted.

Efficacy of Legal Reforms in Managing Conflict of Interest

Managing conflict of interest in the public sector has been and will always be a concern for governments the world over. This is accentuated for several African countries which continue to rank highly on the corruption and bribery indices. Corruption is closely connected to the issue of conflict of interest and consequently, it is important to seek best practices in place to deal effectively with conflict of interest in the public sector. Various tools and legal instruments have been developed by regional and global organizations with the singular aim of aiding their member states to review and modernise their conflict of interest policies. Some African states have either adopted these instruments as forming part of their municipal law or legislated laws on conflict of interest. This article examines the role played by law in defining and regulating conflict of interest and how conflict of interest affects the public sector in Africa. It focuses on how law can be deployed effectively as a tool of establishing governance structures that maintain a culture that minimizes and manages the occurrence of conflict of interest.

Management of evidence and conflict of interest in guidelines on early childhood allergy prevention and child nutrition: study protocol of a systematic synthesis of guidelines and explorative network analysis

Background: With the rising prevalence of allergic diseases in children, prevention of childhood allergies becomes an important public health issue. Recently, a paradigm shift is taking place in the approach to preventing allergies, and clinical practice guidelines (CPG) and food-based dietary guidelines (FBDG) play an important role in providing practitioners with the latest evidence and reliable guidance. However, concern about the methodological quality of the development of FBDGs and CPGs, including limitations in the systematic reviews, lack of transparency and unmanaged conflicts of interest (COI), reduce the trust in these guidelines. Methods: We aim to synthesize the available guidance on early childhood allergy prevention (ECAP) through a systematic search for national and international CPGs and FBDGs concerning ECAP and child nutrition (CN) and to assess the quality of the guidelines and management of COI. Additionally, we will analyse the content and the evidence base of the recommendation statements. We aim to quantify the COI in guideline panellists and explore possible associations between COI and recommendations. Through a social network analysis, we expect to elucidate ties between panellists, researchers, institutions, industry and other sponsors. Guidelines are an important tool to inform healthcare practitioners with the newest evidence, but quality and reliability have to be high. This study will help identify potential for further improvement in the development of guidelines and the management of COI. If the social network analysis proves feasible and reveals more information on COI in comparison to disclosed COI from the previous analyses, the methodology can be developed further to identify undisclosed COIs in panellists. Ethics and dissemination: This research does not require ethical approval because no human subjects are involved. Results will be published in international peer-reviewed open access journals and via presentations at scientific conferences.

Development processes for e-cigarette public health recommendations lacked transparency in managing conflicts of interest

ObjectivesTo investigate how guideline development groups collect and manage conflicts of interest (COI) when producing electronic cigarette (e-cigarette) recommendations. Study Design and SettingPublic health bodies that had produced e-cigarette recommendations were identified from four purposively selected jurisdictions (World Health Organization, United Kingdom, Australia, and United States). We analysed their COI policies and conducted 15 interviews with guideline methodologists, policymakers, and academics in guideline development groups. ResultsOnly five of 10 public health bodies had a publicly available COI policy. Participants discussed the importance of those involved in the development process declaring COI. However, there were differences in who had to report COI, the time period asked about, and what and how declarations are made. COI policies and participants discussed a range of approaches for managing COI, from limiting involvement to disqualification from the recommendation development process. Participants considered the current processes for collecting and managing COI insufficient due to their open interpretation and possibility for partial declarations of interest. ConclusionThe management of COI varies across public health bodies, with little standardization and lack of transparency. To improve the collection and management of COI, and ultimately increase the trustworthiness of recommendations, guideline development groups should draw upon a comprehensive and accessible COI policy.