Many writers of diabetes, cholesterol guidelines have conflicts of interest

Half of experts who write clinical practice guidelines for diabetes and high cholesterol have financial conflicts of interest with the drug industry, a study says.

One in nine panelists who said they had no conflicts actually had a conflict, said the study, published online Oct. 11 in the journal BMJ (link).

"Our main concern is that there is a potential risk of industry influence on developing guideline recommendations," said lead study author Jennifer Neuman, MD, an instructor of preventive medicine at Mount Sinai School of Medicine in New York. "For practitioners and developers alike, it's important to be mindful of this issue."

The study examined 14 guidelines published on diabetes and high cholesterol between 2000 and 2010 by national organizations in the United States and Canada. Those groups included the American Heart Assn. and the American Diabetes Assn. A financial conflict was defined as direct compensation to a guideline panelist by a manufacturer of a drug used to treat the disease of interest in the guideline.

Among 288 panel members who wrote guidelines, 52% had conflicts of interest. Eleven percent who formally declared no conflicts were found to have one or more conflicts. Panel members for government-sponsored guidelines were less likely to have conflicts than guideline writers on nongovernment projects (16% compared with 69%).

The study said organizations that develop guidelines should reduce such conflicts of interest to ensure credibility. Dr. Neuman said there should be a more standardized framework to prevent such conflicts.

"It seems possible to convene panels with minimal conflicts," she said. "Transparency is sort of the first most important step."

Taking action to reduce bias

Other research has shown conflicts of interest among guideline developers. A study in the March 28 Archives of Internal Medicine found that 56% of cardiovascular guideline writers had financial relationships with industry related to the area covered by their guideline committee (link).

In March, the Institute of Medicine issued a report recommending how guideline panels should avoid conflicts of interest. The recommendations include reporting each panel member's financial conflicts before guidelines are developed and disclosing any related activities that generate a substantial proportion of income (link).

At its Annual Meeting in June, the American Medical Association's House of Delegates adopted policy to prevent conflicts of interest when developing medical practice guidelines. The policy calls for such steps as requiring disclosure of all potential conflicts of interest.

Dr. Neuman said she supports efforts by the IOM and others to make guideline development more transparent to decrease possible industry bias.

In response to the BMJ study, the American Heart Assn. said it has strict policies to prevent industry influence. The association said it refined those policies in 2010 to require more stringent management of relationships with industry.

"We will continue to look closely at our policies regarding relationships with industry and will continue to enhance our practices in the future," the AHA said in a statement.

The American Diabetes Assn. now asks for financial disclosures before panelists get on a committee, said Sue Kirkman, MD, the association's senior vice president of medical affairs and community information. The association is working to improve the process.

"We are trying to be more and more careful about avoiding conflicts of interest in our guideline writing groups," Dr. Kirkman said.