FOR the first time a study has examined potential financial conflicts of interest for authors of clinical practice guidelines¹. These authors' interactions with the pharmaceutical industry may be particularly relevant since such guidelines are designed to influence the decisions of large numbers of doctors. Eighty-seven percent of the 100 authors who responded to the University of Toronto survey had some type of financial relationship with a pharmaceutical company.

The study involved a cross-sectional survey of medical experts who participated in writing 44 clinical practice guidelines, covering conditions such as asthma, diabetes and pneumonia. Fiftyeight percent had received financial support to perform research and 38% had served as employees or consultants for a pharmaceutical company. On average, clinical practice guideline authors interacted with 10.5 different companies. Fifty-nine percent had relationships with companies whose drugs were considered in the guideline they authored, and of these authors 96% had relationships that predated the guideline creation process.

No formal process

Fifty-five percent of respondents indicated that there had been no formal procedure for declaring these relationships when they became involved in the guideline process. In published versions of the clinical practice guidelines, there were only two cases of specific declarations regarding the personal financial interactions of individual authors with the pharmaceutical industry. Only 7% of respondents thought that their own relationships with the pharmaceutical industry influenced the recommendations made, but 19% thought that their co-authors' recommendations were influenced by their relationships.

Need for disclosure

Although the survey was small, the researchers conclude that there appears to be considerable interaction between clinical practice guideline authors and the pharmaceutical industry. They advocate appropriate disclosure of financial conflicts of interest for guideline authors, and a formal process for discussing these conflicts prior to guideline development.

Reference

1. Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002;287: 612 - 617.

Guidelines on financial conflicts of interest

THE Association of American Medical Colleges has released the first report of its Task Force on Financial Conflicts of Interest in Clinical Research, "Protecting Subjects, Preserving Trust, Promoting Progress: Policy and Guidelines for the Oversight of Individual Financial Interests in Research." The guidelines propose that institutions adopt high standards for the reporting, review and disclosure of researchers' financial interests in federally funded and privately sponsored human subjects research.

The report recommends that academic institutions presume that any individual holding a significant financial interest in human subject research may not conduct that research, unless the researcher can demonstrate to a reviewing body that the circumstances are compelling. The report also recognises that each potential conflict of interest case must be closely examined on its merits, and the reviewers must respect the institutional, individual and scientific circumstances surrounding it. To achieve this, the

Task Force recommends that academic institutions appoint a standing Conflicts of Interest Committee.

Further information is available on the web at: http://www.aamc.org/coitf