An investigation published on bmj.com today showed that members of guideline panels in the U.S. and Canada have a high prevalence of conflicts and high numbers of under-reporting conflicts of interest (COI).
The problem of incomplete disclosure is exposed in the investigation, which also underlines the crucial relationship between presence of COI and sponsorship guidelines.
For over 20 years the incidence of COI among industry and clinicians has been a concern for the medical profession.
Because freedom from bias is important, the development of clinical practical guidelines is one area of particular concern for the presence of COI.
Even though the majority of companies that create guidelines have adopted conflict on interest disclosure policies, they are not usually clear, and might not be enough to stop members of guideline panels bias from influencing recommendations.
A group of U.S. investigators decided to establish the prevalence of financial COI among guideline panelists from organizations that were seen as having the best clinical practice and influence behavior by using the Institute of Medicine's recommendations as a basis.
The researchers assessed 14 guidelines that were published between 2000 and 2010 by national organizations in the U.S. and Canada that included screening for diabetes and high cholesterol (hyperlipidaemia) and treatment.
They discovered that conflicts of interest were present in most of the guidelines panels reviewed.
Overall, 52% (150) of members on panels had conflicts of interest, 12 were undeclared and 138 declared. Half of panels that had chairs had COI. Compared to guidelines sponsored by non-government sources, members of guideline panels that were sponsored by the government were less likely to have conflicts of interest.
The researchers explain:
"Our data illustrate the pervasiveness of COI among members of guideline panels and may raise questions about the independence and objectivity of the guideline development process in the United States and Canada."
They highlight that limited conflict of interest discovered among members of guideline panels that were sponsored by the government "suggests that expert panels without many COI can be convened."
"Conflict-free guideline panels are feasible and would help improve the quality of the guideline development process."
In an associated report, Professor Edwin Gale reasons that academic and non-academic medicine "are pervaded by conflicts of interest, and too many people benefit from the situation for this to be openly acknowledged."
Gale believes that in the culture of medicine a change is needed. "Until then, the drug industry will continue to model its behavior on that of its consumers, and we will continue to get the drug industry we deserve."
Written by Grace Rattue