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Conflict of Interest in Clinical Practice Guideline Development: A Systematic Review

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  • Susan L Norris
  • Haley K Holmer
  • Lauren A Ogden
  • Brittany U Burda

Abstract

Background: There is an emerging literature on the existence and effect of industry relationships on physician and researcher behavior. Much less is known, however, about the effects of these relationships and other conflicts of interest (COI) on clinical practice guideline (CPG) development and recommendations. We performed a systematic review of the prevalence of COI and its effect on CPG recommendations. Methodology/Principal Findings: We searched Medline (1980 to March, 2011) for studies that examined the effect of COI on CPG development and/or recommendations. Data synthesis was qualitative. Twelve studies fulfilled inclusion criteria; 9 were conducted in the US. All studies reported on financial relationships of CPG authors with the pharmaceutical industry; 1 study also examined relationships with diagnostic testing and insurance companies. The majority of guidelines had authors with industry affiliations, including consultancies (authors with relationship, range 6–80%); research support (4–78%); equity/stock ownership (2–17%); or any COI (56–87%). Four studies reported multiple types of financial interactions for individual authors (number of types per author: range 2 to 10 or more). Data on the effect of COI on CPG recommendations were confined to case studies wherein authors with specific financial ties appeared to benefit from the related CPG recommendations. In a single study, few authors believed that their relationships influenced their recommendations. No studies reported on intellectual COI in CPGs. Conclusions/Significance: There are limited data describing the high prevalence of COI among CPG authors, and only case studies of the effect of COI on CPG recommendations. Further research is needed to explore this potential source of bias.

Suggested Citation

  • Susan L Norris & Haley K Holmer & Lauren A Ogden & Brittany U Burda, 2011. "Conflict of Interest in Clinical Practice Guideline Development: A Systematic Review," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-6, October.
    • Handle: RePEc:plo:pone00:0025153
    DOI: 10.1371/journal.pone.0025153
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    References listed on IDEAS

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    1. Rosie Taylor & Jim Giles, 2005. "Cash interests taint drug advice," Nature, Nature, vol. 437(7062), pages 1070-1071, October.
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    1. Tanya Graham & Phil Alderson & Tim Stokes, 2015. "Managing Conflicts of Interest in the UK National Institute for Health and Care Excellence (NICE) Clinical Guidelines Programme: Qualitative Study," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-10, March.
    2. Tao Liu & Benjamin Quasinowski & André Soares, 2020. "The Emulation and Adaptation of a Global Model of Clinical Practice Guidelines on Chronic Heart Failure in BRICS Countries: A Comparative Study," IJERPH, MDPI, vol. 17(5), pages 1-21, March.
    3. Sheryl Spithoff & Pamela Leece & Frank Sullivan & Nav Persaud & Peter Belesiotis & Liane Steiner, 2020. "Drivers of the opioid crisis: An appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    4. Joanne Khabsa & Jennifer Petkovic & Alison Riddle & Lyubov Lytvyn & Olivia Magwood & Pearl Atwere & Pauline Campbell & Srinivasa V. Katikireddi & Bronwen Merner & Mona Nasser & Stephanie Chang & Aleja, 2022. "PROTOCOL: Conflict of interest issues when engaging stakeholders in health and healthcare guideline development: a systematic review," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(2), June.
    5. Susan L Norris & Haley K Holmer & Brittany U Burda & Lauren A Ogden & Rongwei Fu, 2012. "Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-12, May.
    6. Jeffrey Sonis & Olivia M Chen, 2020. "Approval processes in evidence-based clinical practice guidelines sponsored by medical specialty societies," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-9, February.
    7. Damien Wyssa & Martin R Tramèr & Nadia Elia, 2019. "Reporting of conflicts of interest and of sponsorship of guidelines in anaesthesiology. A cross-sectional study," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-13, February.
    8. Lisa Bero, 2018. "Meta-research matters: Meta-spin cycles, the blindness of bias, and rebuilding trust," PLOS Biology, Public Library of Science, vol. 16(4), pages 1-4, April.
    9. Joseph Pozsgai-Alvarez & Iván Pastor Sanz, 2021. "Mapping the (anti-)corruption field: key topics and changing trends, 1968–2020," Journal of Computational Social Science, Springer, vol. 4(2), pages 851-881, November.
    10. Wang, Zhicheng & Bero, Lisa & Grundy, Quinn, 2021. "Understanding professional stakeholders’ active resistance to guideline implementation: The case of Canadian breast screening guidelines," Social Science & Medicine, Elsevier, vol. 269(C).
    11. Unruh, Lynn & Rice, Thomas & Rosenau, Pauline Vaillancourt & Barnes, Andrew J., 2016. "The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization?," Health Policy, Elsevier, vol. 120(7), pages 797-808.
    12. Yidan Lu & Derek J Jones & Nour Sharara & Tonya Kaltenbach & Loren Laine & Kenneth McQuaid & Roy Soetikno & Venkataraman Subramanian & Alan Barkun, 2017. "Transparency ethics in practice: Revisiting financial conflicts of interest disclosure forms in clinical practice guidelines," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-11, August.
    13. Susan L Norris & Haley K Holmer & Lauren A Ogden & Brittany U Burda & Rongwei Fu, 2013. "Conflicts of Interest among Authors of Clinical Practice Guidelines for Glycemic Control in Type 2 Diabetes Mellitus," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    14. Cristina Morciano & Vittorio Basevi & Carla Faralli & Michele Hilton Boon & Sabina Tonon & Domenica Taruscio, 2016. "Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-24, November.
    15. Susan L Norris & Haley K Holmer & Lauren A Ogden & Shelley S Selph & Rongwei Fu, 2012. "Conflict of Interest Disclosures for Clinical Practice Guidelines in the National Guideline Clearinghouse," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-8, November.

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