Relationships Between Authors of Clinical Practice Guidelines and the Pharmaceutical Industry

Context Increasing contact has been reported between physicians and the pharmaceutical industry, although no data exist in the literature regarding potential financial conflicts of interest for authors of clinical practice guidelines (CPGs). These interactions may be particularly relevant since CPGs are designed to influence the practice of a large number of physicians.

Objective To quantify the extent and nature of interactions between authors of CPGs and the pharmaceutical industry.

Design, Setting, and Participants Cross-sectional survey of 192 authors of 44 CPGs endorsed by North American and European societies on common adult diseases published between 1991 and July 1999. One hundred authors (52%) provided usable responses representing 37 of 44 different CPGs that we identified.

Main Outcome Measures Nature and extent of interactions of authors with drug manufacturers; disclosure of relationships in published guidelines; prior discussion among authors regarding relationships; beliefs regarding whether authors' own relationships or those of their colleagues influenced treatment recommendations in guidelines.

Results Eighty-seven percent of authors had some form of interaction with the pharmaceutical industry. Fifty-eight percent had received financial support to perform research and 38% had served as employees or consultants for a pharmaceutical company. On average, CPG authors interacted with 10.5 different companies. Overall, an average of 81% (95% confidence interval, 70%-92%) of authors per CPG had interactions. Similarly, all of the CPGs for 7 of the 10 diseases included in our study had at least 1 author who had some interaction. 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. Fifty-five percent of respondents indicated that the guideline process with which they were involved had no formal process for declaring these relationships. In published versions of the CPGs, specific declarations regarding the personal financial interactions of individual authors with the pharmaceutical industry were made in only 2 cases. Seven percent thought that their own relationships with the pharmaceutical industry influenced the recommendations and 19% thought that their coauthors' recommendations were influenced by their relationships.

Conclusions Although the response rate for this survey was low, there appears to be considerable interaction between CPG authors and the pharmaceutical industry. Our study highlights the need for appropriate disclosure of financial conflicts of interest for authors of CPGs and a formal process for discussing these conflicts prior to CPG development.

Interactions between physicians and the pharmaceutical industry have received increasing amounts of attention over the last several years. Several authors have described significant contact between the pharmaceutical industry and academic researchers,¹ faculty physicians,² community physicians,³ residents,⁴ and medical students.⁵ More importantly, these types of interactions have been shown to influence prescribing patterns,⁶ stimulate requests for addition of drugs to hospital formularies,² result in favorable publications⁷ and research articles,^8,9 and be related to the lack of publication of unfavorable articles.¹⁰

Clinical practice guidelines (CPGs) are intended to present a synthesis of current evidence and recommendations preformed by expert clinicians and may affect the practice of large numbers of physicians. As a result, any influence that the authors of CPGs experience from their interactions with pharmaceutical companies may be transmitted many times over to the readers of CPGs. Consequently, if individual authors have relationships that pose a potential conflict of interest, readers of these CPGs may wish to know about them to evaluate the merit of those guidelines.

To date, no published data exists regarding the extent to which the authors of CPGs interact with the pharmaceutical industry. This study seeks to provide empirical evidence concerning this issue to improve the process of CPG development in the future.