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Most Clinical Practice Guideline Authors Receive Drug Industry Support

Kate Traynor

The authors of clinical practice guidelines have extensive ties to the pharmaceutical industry, according to a recent report.1

A survey of clinical practice guideline authors revealed that 87% had a financial relationship with at least one drug company. On average, each of these authors had dealings with 10.5 different drug companies.

Sixty-four percent of the survey respondents said they had received honoraria from the drug industry for speaking engagements, making this the most common type of financial relationship. More than half of the respondents reported receiving travel funding or honoraria, research support, or educational programming support from the drug industry. Thirty-eight percent of respondents were employed by or consulted for the industry. Six percent owned an equity stake in one or more drug companies.

The survey was mailed to 192 authors of 44 clinical practice guidelines describing the management of common diseases, such as pneumonia, coronary artery disease, asthma, and hypertension. All of the guidelines in the study had been endorsed by at least one major North American or European society on common adult diseases. Although the survey’s questions dealt with authors’ relationships with drug companies, the guideline topics were not restricted to drug therapy but also described diagnosis and other aspects of disease management.

A total of 100 authors representing 37 clinical practice guidelines completed the survey. The guideline authors were not promised that their responses would remain anonymous, a factor that the survey team conceded may have lowered the response rate.

All 44 guidelines were examined to determine whether they included a conflict-of-interest statement. All but two of the published guidelines lacked a statement indicating whether the authors had declared a potential conflict of interest. One guideline contained a statement that the authors had personal financial dealings with the pharmaceutical industry. Another guideline declared that none of the authors had a conflict of interest.

One fourth of the 44 clinical practice guidelines that were examined contained a declaration that a pharmaceutical company had sponsored the guideline. Nine guidelines received support from "nonindustry organizations."

Fifty-nine percent of the 80 respondents who returned a follow-up survey acknowledged having a relationship with one or more companies whose drugs were considered in the guideline. In all but two cases, the relationship with the sponsor predated the creation of the guideline.

A subset of nearly 70 guideline authors offered their opinion of how the relationship with a drug company influenced the guideline-creation process. Five said that the relationship influenced their personal recommendations, but 13 said that such relationships influenced the recommendations of their colleagues.

One of the guidelines2 used for the study was produced by ASHP, but the report did not provide a breakdown of individual guideline or author data.

  1. Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA. 2002; 287:612-7. 
  2. ASHP therapeutic guidelines on angiotensin-converting enzyme inhibitors in patients with left ventricular dysfunction. Am J Health-Syst Pharm 1997; 54:299-313.

All authors who are involved in developing therapeutic guidelines for ASHP are asked beforehand to complete a conflict-of-interest disclosure report. In the report, the author is asked to list financial benefits, including grants, honoraria, consulting fees, and gifts received during the past year. Disclosure is limited to awards of $10,000 or more and those that exceed 10% of the author’s gross annual income.

Potential authors are also asked whether they have participated on a health-related advisory panel, regulatory board, or similar program within the past year or have contributed to non-ASHP publications.