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Eliminating Conflicts of Interest in Clinical Guideline Development—Is it Possible?

Posted on | April 2, 2011 | No Comments

Judy Salerno

A variety of professions offer ripe environments for conflict of interest, and most every field these days is considering conflict of interest policies to mitigate the appearance or actuality of a problem. In the medical profession, there is a critical need for conflict of interest policies, and rigorous standards generally, around the development of clinical practice guidelines.

A 2009 report from the Institute of Medicine (IOM) examined conflicts of interest in medicine and recommended steps to identify, limit, and manage such conflicts. More recently, the IOM issued a report that recommended the strictest standards yet for guideline development groups—standards designed to ensure objective, transparent development of trustworthy guidelines. To prevent conflicts of interest—whether actual or perceived—from undermining the public’s trust, the report says that members of guideline development groups should not have intellectual, institutional, financial, or other forms of conflicts whenever possible.

On the heels of our report comes a new study in the Archives of Internal Medicine that illustrates precisely why such standards are needed. The study found that for all of the cardiology treatment guidelines from the American College of Cardiology/American Heart Association since 2008, more than half of the guideline developers were shown to have a conflict of interest. As a nation, we put our trust in guideline developers to establish evidence-based recommendations as to how clinicians should treat patients. Americans must be confident that their medical treatment is guided by the most trustworthy of sources or we risk an erosion of trust in the medical profession as a whole.

The IOM’s report is the latest to point to the need for the elimination of conflict of interest in guideline development, but it is also among the first to focus not on the problem but on the solution. The prevalence of conflicts among guideline developers is not an easy situation to fix, and we may never eliminate such conflicts completely. But it is a problem we have to try to resolve if patients are to get the best care possible and to trust in that care. And last week’s study makes that ever clearer.

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