Financial conflicts of interest in guidelines

A new study published in the BMJ shows the prevalence of financial conflicts of interest in the panel members producing clinical guidelines. For consumers of healthcare delivery (that means everyone), I think it is valuable to know that doctors get their information from guidelines, and about half of the people developing those guidelines have financially-based conflicts of interest (e.g. they get money from pharmaceutical companies). The fact that this is not a surprise is probably the most worrying issue.

This is the second time that we’ve heard that journals have become “an extension of the marketing arm of pharmaceutical companies”.

Unfortunately, the double-edged sword is that many talented people do excellent work, and get money from pharmaceutical companies. Removing financial conflicts of interest would remove their talent from the construction of evidence and guidelines. 

Measuring only skin deep conflicts of interest won’t help

Conflicts of Interest in Cardiovascular Clinical Practice Guidelines

In the most recent issue of Archives, a group of US researchers have analysed the cardiovascular clinical practice guidelines on which clinicians rely to make informed decisions about how best to treat patients. Conflicts of interest are contentious in this area because they are known to influence how evidence is reported in a number of interesting ways.

The authors find that conflicts of interest were not as large a problem as many might imagine them to be. My argument here is that 56% of the authors of the clinical practice guidelines may be supported partially (or more) by pharmaceutical companies but they are still writing guidelines based on evidence that may be more dependent on big pharma, from clinical trials that may be funded and designed by big pharma, and with the concerted effort of a 900 billion dollar industry helping them reinforce the need for more pills.