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Abstract & Commentary
Source: Choudhry NK, et al. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002;287:612-617.
During the last several years, the relationship between physicians and the pharmaceutical industry has come under increasing scrutiny. However, no literature has been published examining potential financial conflicts of interest for authors of commonly used clinical practice guidelines (CPGs).
This cross-sectional study from Toronto surveyed 192 authors of 44 CPGs on common diseases endorsed by North American and European specialty societies. Authors were identified by reviewing CPGs published between 1991 and 1999. The list of medical conditions to be included was created using the 20 most commonly prescribed medications and the five most common admission diagnoses at the involved hospitals.
Surveys were mailed to the 192 authors of 44 CPGs, seeking answers to four specific questions: 1) how much interaction do authors of CPGs have with drug manufacturers; 2) what physician/industry interactions are disclosed in the published CPGs; 3) prior to creating the CPG, was there any discussion among the authors regarding relationships with the pharmaceutical industry; and 4) do CPG authors believe that their relationships, or those of their colleagues, to the pharmaceutical industry influenced the treatment recommendations made in the CPG?
Fifty-seven percent of authors responded. Of these, 87% had some interaction with the pharmaceutical industry. Fifty-eight percent had received financial support for research, and 38% had been employees or consultants for a pharmaceutical company. On average, the CPG authors interacted with 10.5 different companies. For seven of the 10 diseases included, all CPGs had at least one author with ties to a pharmaceutical company.
Fifty-nine percent of authors had ties to companies whose drugs were considered in the CPG they authored. Fifty-five percent reported no formal process for declaring conflicts of interest for the guidelines process in which they were involved. Only two of the CPGs published specific declarations regarding the personal financial interactions of individual authors. Seven percent of CPG authors believe they were influenced by their relationship with the pharmaceutical industry, and 19% believe their co-authors were influenced.
The authors concluded that despite poor survey return, there appears to be considerable interaction between CPG authors and the pharmaceutical industry. These findings highlight the need for appropriate disclosure of financial conflicts of interest for CPG authors.
Commentary by Jacob W. Ufberg, MD
It is not surprising that the authors of these CPGs have such frequent ties to the pharmaceutical industry. The same "experts" who obtain research funding from these companies are likely to be the ones asked to participate in the creation of treatment guidelines.
However, for only 7% to believe they were influenced borders on the absurd. Studies have shown, as the authors point out, that significant interactions with the pharmaceutical industry influence prescribing patterns, stimulate requests for the addition of medications to hospital formularies, result in favorable publications, and are related to the lack of publication of unfavorable studies. In fact, some of these CPGs actually are sponsored by pharmaceutical companies.
While the interactions of these physician/authors with the pharmaceutical industry are unlikely to cease, one thing is quite clear—there is a dire need for these CPGs to include authors’ disclosures of financial conflicts of interest.
Dr. Ufberg, Assistant Professor of Emergency Medicine, Assistant Residency Director, Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, is on the Editorial Board of Emergency Medicine Alert.