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Practice Guidelines May Be Influenced by Drug Companies

JAMA 2002;287:612-617.

NEW YORK (Reuters Health) - Most authors of clinical practice guidelines (CPG) have had some form of interaction with the pharmaceutical industry, according to a report published in the February 6th issue of The Journal of the American Medical Association. In fact, several authors reported that these interactions actually influenced the guidelines.
Dr. Allan S. Detsky, from Mount Sinai Hospital in Toronto, and colleagues conducted a cross-sectional survey of 192 authors of 44 CPGs to ascertain the nature and extent of their interactions with the pharmaceutical industry. The usable response rate was 52%.

Eight-seven percent of authors reported some form of interaction with drug companies, the investigators note. Nearly 60% of these authors said they had received financial support from pharmaceutical companies to perform research. More than a third of the authors reported actually working for a drug company at some point.

CPG authors interacted with a mean of 10.5 companies. On any given CPG, an average of 81% of the authors had interacted with drug companies, the researchers state.

Close to 60% of authors had relationships with a company whose drugs were considered in the CPG being created. Almost all of these authors reported contact with the drug company prior to the CPG creation process.

Fifty-five percent of respondents said the guideline process they were involved with had no formal protocol for disclosing relationships with drug companies. In only 2 of the 44 published CPGs was it made clear that the authors were financially involved with the pharmaceutical industry.

Only 7% of authors believed that their relationship with a drug company influenced their recommendations. However, 19% of authors thought that their co-author's relationships with drug companies did influence the guidelines.

The investigators note that one weakness of the current study was the low response rate. Despite this, the findings do suggest that there is "considerable interaction between CPG authors and the pharmaceutical industry," they add. Furthermore, these interactions have the potential to "influence the practice of a very large number of physicians."

Financial conflicts of interest need to be disclosed, Dr. Detsky's group concludes. In addition, they believe that a formal process needs to be in place so that these conflicts can be discussed prior to CPG creation.