This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (142)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Drug Therapy, Other  • Conflict of Interest  • Alert me on articles by topic

Niteesh K. Choudhry, MD,FRCPC; Henry Thomas Stelfox, MD,FRCPC; Allan S. Detsky, MD,PhD,FRCPC

JAMA. 2002;287:612-617.

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.

Author Affiliations: Departments of Medicine (Drs Choudhry, Stelfox, and Detsky) and Health Policy, Management and Evaluation (Dr Detsky), University of Toronto, and Department of Medicine, University Health Network and Mount Sinai Hospital (Drs Choudhry and Detsky), Toronto, Ontario; and the PhD Program in Health Care Policy, Harvard University, Boston, Mass (Drs Choudhry and Stelfox).

RELATED ARTICLE

February 6, 2002
JAMA. 2002;287(5):655-656.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Heterogeneity in cancer guidelines: should we eradicate or tolerate?
Pentheroudakis et al.
Ann Oncol 2008;0:mdn418v1-mdn418.
ABSTRACT | FULL TEXT  

Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical practice guidelines
Holloway et al.
Neurology 2008;71:57-63.
ABSTRACT | FULL TEXT  

Invited Article: Threats to physician autonomy in a performance-based reimbursement system
Larriviere and Bernat
Neurology 2008;70:2338-2342.
ABSTRACT | FULL TEXT  

Brief Reports: Psychiatric Opinion and Antipsychotic Selection in the Management of Schizophrenia
Arbuckle et al.
Psychiatr. Serv. 2008;59:561-565.
ABSTRACT | FULL TEXT  

Impugning the Integrity of Medical Science: The Adverse Effects of Industry Influence
DeAngelis and Fontanarosa
JAMA 2008;299:1833-1835.
FULL TEXT  

Developing Clinical Recommendations for Breast, Colorectal, and Lung Cancer Adjuvant Treatments Using the GRADE System: A Study From the Programma Ricerca e Innovazione Emilia Romagna Oncology Research Group
De Palma et al.
JCO 2008;26:1033-1039.
ABSTRACT | FULL TEXT  

A guide to the Canadian Medical Association Handbook on Clinical Practice Guidelines
Palda et al.
CMAJ 2007;177:1221-1226.
FULL TEXT  

Is P4P Really FFS?
Wodchis et al.
JAMA 2007;298:1797-1799.
FULL TEXT  

Disclosure of Conflicts of Interest by Authors of Clinical Trials and Editorials in Oncology
Riechelmann et al.
JCO 2007;25:4642-4647.
ABSTRACT | FULL TEXT  

Conflict of Interest in Clinical Practice
Tonelli
Chest 2007;132:664-670.
ABSTRACT | FULL TEXT  

Use and Perceptions of Clinical Practice Guidelines by Internal Medicine Physicians
Shea et al.
American Journal of Medical Quality 2007;22:170-176.
ABSTRACT  

Influence of Industry on Renal Guideline Development
Coyne
CJASN 2007;2:3-7.
FULL TEXT  

American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders Compendium 2006
Glass
JAMA 2006;296:2620-2621.
FULL TEXT  

Sources of bias for authors of clinical practice guidelines.
Detsky
CMAJ 2006;175:1033- 1035.
FULL TEXT  

Sources de partialite chez les auteurs de guides de pratique clinique
Detsky
CMAJ 2006;175:1035-1035.
FULL TEXT  

Considered judgement in evidence-based guideline development
Verkerk et al.
Int J Qual Health Care 2006;18:365-369.
ABSTRACT | FULL TEXT  

Translating Epoetin Research Into Practice: The Role Of Government And The Use Of Scientific Evidence
Cotter et al.
Health Aff (Millwood) 2006;25:1249-1259.
ABSTRACT | FULL TEXT  

NICE work: level playing field requires transparency.
Minhas
BMJ 2006;332:1394-1394.
FULL TEXT  

President's Page: American College of Cardiology Fellowship: Where Ideals and Personal Responsibility Intersect
Nissen and President, American College of Cardiology
J Am Coll Cardiol 2006;47:1901-1903.
FULL TEXT  

Not all guidelines are created equal.
Hoey
CMAJ 2006;174:815-815.
FULL TEXT  

Beyond the 'New Cross-cultural Psychiatry': Cultural Biology, Discursive Psychology and the Ironies of Globalization
Kirmayer
Transcultural Psychiatry 2006;43:126-144.
ABSTRACT  

The New Standing Guideline Committee Policy of the American Stroke Association Stroke Council
Saver and Goldstein
Stroke 2006;37:753-753.
FULL TEXT  

Assessing and scaling the knowledge pyramid: the good-guideline guide
Davis et al.
CMAJ 2006;174:337-338.
FULL TEXT  

Part 1: Introduction
Circulation 2005;112:IV-1-IV-5.
FULL TEXT  

Management of Conflict of Interest Issues in the Activities of the American Heart Association Emergency Cardiovascular Care Committee, 2000-2005
Billi et al.
Circulation 2005;112:IV-204-IV-205.
FULL TEXT  

Part 1: Introduction
Circulation 2005;112:III-1-III-4.
FULL TEXT  

Medical Students' Exposure to and Attitudes About Drug Company Interactions: A National Survey
Sierles et al.
JAMA 2005;294:1034-1042.
ABSTRACT | FULL TEXT  

Conflict of Interest: Can We Minimize Its Influence in the Biomedical Literature?
Neale et al.
J Am Board Fam Med 2005;18:411-413.
FULL TEXT  

The Effect of Conflict of Interest on Biomedical Research and Clinical Practice Guidelines: Can We Trust the Evidence in Evidence-Based Medicine?
Abramson and Starfield
J Am Board Fam Med 2005;18:414-418.
FULL TEXT  

The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers?
Genuis
J Am Board Fam Med 2005;18:419-425.
ABSTRACT | FULL TEXT  

The Role of the Pharmaceutical Industry in Teaching Psychopharmacology: A Growing Problem
Brodkey
Acad. Psychiatry 2005;29:222-229.
ABSTRACT | FULL TEXT  

Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society
Holloway et al.
Neurology 2005;64:172-174.
FULL TEXT  

Implications of Pharmaceutical Industry Funding on Clinical Research
Lexchin
The Annals of Pharmacotherapy 2005;39:194-197.
ABSTRACT | FULL TEXT  

The Ethical Conduct of Clinical Research Involving Critically Ill Patients in the United States and Canada: Principles and Recommendations
Am. J. Respir. Crit. Care Med. 2004;170:1375-1384.
FULL TEXT  

Doctors and Drug Companies
Blumenthal
NEJM 2004;351:1885-1890.
FULL TEXT  

Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia
Dodek et al.
ANN INTERN MED 2004;141:305-313.
ABSTRACT | FULL TEXT  

Brains, claims, and the pharmaceutical industry
Alberts et al.
BMJ 2003;327:E107-109.
FULL TEXT  

Standardized Reporting of Clinical Practice Guidelines: A Proposal from the Conference on Guideline Standardization
Shiffman et al.
ANN INTERN MED 2003;139:493-498.
ABSTRACT | FULL TEXT  

American College of Cardiology/American Heart Association Clinical Practice Guidelines: Part I: Where Do They Come From?
Gibbons et al.
Circulation 2003;107:2979-2986.
FULL TEXT  

Clinical guidelines
Keeley
Palliat Med 2003;17:368-374.
ABSTRACT  

Getting it right: industry sponsorship and medical research
Baird
CMAJ 2003;168:1267-1269.
FULL TEXT  

Is academic psychiatry for sale?
Healy and Thase
Br. J. Psychiatry 2003;182:388-390.
FULL TEXT  

The power of clinical trials and guidelines,and the challenge of conflicts of interest
Bruce Fye
J Am Coll Cardiol 2003;41:1237-1242.
FULL TEXT  

Recommendations for the Relationship Between Sponsors and Investigators in the Design and Conduct of Clinical Stroke Trials
Donnan et al.
Stroke 2003;34:1041-1045.
ABSTRACT | FULL TEXT  

First among Equals?: Does drug treatment for dementia claim more than its fair share of resources?
Heller and Heller
Dementia 2003;2:7-19.
ABSTRACT  

Integrating quality into the cycle of therapeutic development
Califf et al.
J Am Coll Cardiol 2002;40:1895-1901.
ABSTRACT | FULL TEXT  

The invisible hand of the marketing department
CMAJ 2002;167:5-5.
FULL TEXT  

La main invisible du marketing
CMAJ 2002;167:7-7.
FULL TEXT  

User-led research and evidence in psychiatry * Authors' reply
van Beinum et al.
Br. J. Psychiatry 2002;180:549-550.
FULL TEXT  

Guideline Authors Often Have Industry Ties
Journal Watch Cardiology 2002;2002:1-1.
FULL TEXT  

Alteplase for stroke: money and optimistic claims buttress the "brain attack" campaign * Commentary: Who pays the guideline writers? * Commentary: Thrombolysis in stroke: it works!
Lenzer et al.
BMJ 2002;324:723-729.
FULL TEXT