Researchers at Mount Sinai School of Medicine say they have found that conflicts of interest are prevalent and potentially underreported among individuals participating in the development of clinical practice guidelines, which greatly influence standards of patient care.

In a study published online BMJ: The British Medical Journal. the researchers say their findings provide more evidence of the potential influence of industry on medical practice recommendations.

How, exactly, do you measure a potential conflict of interest? The Mount Sinai team reviewed the panel members involved in the development of clinical practice guidelines for two highly prevalent conditions— diabetes and high cholesterol—from major organizations in the United States and Canada, such as the American Diabetes Association (ADA), the American Heart Association (AHA), and government-sponsored organizations, such as the U.S. Preventive Services Task Force (USPSTF).

Conflicts? What conflicts?

Of the 288 total panel members evaluated, 150, or 52 percent, had what the researchers consider a conflict of interest. In addition, they found that panel members developing government-sponsored guidelines had significantly fewer conflicts than those from the non-government sponsored guideline panels. Lastly, they revealed that one out of nine panelists who formally declared no conflict did, in fact, have a conflict of interest.

“Guidelines inform evidence-based practice and ultimately protect patients, so safeguarding against potential sources of bias is important," said the study’s lead author Jennifer Neuman, MD, Instructor of Preventive Medicine at Mount Sinai School of Medicine. “The majority of guideline panel members and half of guideline panel chairs in our study received some sort of compensation from industry, indicating a risk of industry influence on guideline recommendations. But, we found that government agencies were able to effectively staff their guideline panels with individuals with few conflicts of interest, therefore it is possible to convene panels with minimal conflict of interest.”

Many consumer advocates have warned that drug companies have, over the years, compromised the independent judgment of medical panel participants with cash and gifts, creating a conflict of interest between doctors and pharmaceutical companies and medical device manufacturers.

In a 2009 report, the New Jersey Department of Consumer Affairs issued a set of recommendations to address the impact of potential conflicts on patient care, and set forth new policies to be considered by the state Board of Medical Examiners, the Board of Pharmacy, the Department of Health and Senior Services and academic medical centers.

The U.S. Food and Drug Administration has also promised more transparency in the drug approval process.

Greater transparency

The Mount Sinai authors said they support the efforts by the Institute of Medicine and other prominent medical organizations around the world to increase transparency and decrease potential industry bias on guideline development panels.

“Conflict-free guideline panels are feasible and would help to improve the quality of the guideline development process,” they concluded.


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