Clinical Practice Guidelines and Managing Financial Conflicts of Interest

Abstract

Clinical practice guidelines (CPGs) are becoming essential for doctors to be able to deliver evidence‐based healthcare to their patients but the organisations and committees that sponsor and write the CPGs often have financial conflicts of interest (FCOI) with pharmaceutical companies whose products are recommended in the CPG. The existence of FCOI is a concern as it may compromise the quality of the CPG. Since the main concern is whether the quality of CPGs is biased by FCOI, the next section examines the quality of guidelines and the recommendations that they make. If FCOI is a problem, as I argue, then reforms are necessary. Both the Guidelines International Network and the United States Institute of Medicine have proposed ways of dealing with FCOI and their strengths and weaknesses are explored. Finally, I propose additional measures to help CPGs achieve their potential to help clinicians.

Key Concepts

  • Clinical practice guidelines (CPGs) are becoming increasingly necessary as medical problems become more complex.
  • Financial conflicts of interest (FCOI) are a potential threat to the integrity of CPGs.
  • FCOI among members of committees that write CPGs, chairs of committees and organisations that sponsor CPGs is widespread.
  • There is an association between the presence of FCOI and the quality of recommendations in CPGs.
  • Both the Guidelines International Network and the United States Institute of Medicine (now the National Academy of Medicine) have proposed ways of dealing with FCOI.
  • Additional reforms are necessary to ensure that CPGs are free of the bias that FCOI introduces.

Keywords: bias; clinical practice guidelines; committee chair; committee member; financial conflict of interest; pharmaceutical industry; sponsoring organisations

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Further Reading

Angell M (2004) The Truth about the Drug Companies: How They Deceive Us and What to Do About It. Random House: New York.

Brody H (2007) Hooked: How Medicine's Dependence on the Pharmaceutical Industry Undermines Professional Ethics. Rowman & Littlefield: Lanham, MD.

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Gotzsche P (2013) Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. Radcliffe Publishing: London.

Kassirer J (2005) On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health. Oxford University Press: New York.

Sismondo S (2018) Ghost‐managed Medicine: Big Pharma's Invisible Hands. Mattering Press: Manchester.

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Lexchin, Joel(Sep 2020) Clinical Practice Guidelines and Managing Financial Conflicts of Interest. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0029129]