Many doctors who write practice guidelines have ties to the drug industry
New YorkJanice Hopkins Tanne
About a third of authors who write practice guidelines in the United States have ties to the pharmaceutical industry, a survey by the journal Nature has discovered (2005;437:1070-1). About 70% of writing panels were affected.
Nature’s journalists surveyed 215 guidelines deposited with the US National Guideline Clearinghouse in 2004. All 215 guidelines concerned drugs. But only 90 contained details of the authors’ conflicts of interest, and, of these, only 31 guidelines were free of ties to industry.
A total of 685 authors contributed to the 90 guidelines that Nature investigated. The researchers found that:
- 445 authors (65%) declared no conflict of interest
- 143 (21%) had an advisory board or consultancy position with a relevant company
- 153 (22%) had a research grant from a relevant company
- 103 (15%) had a position on a drug company resource panel of expert doctors
- 16 (2%) held stock in a relevant company
- 10 (1%) mentioned a different conflict of interest.
The article also reported that the Center for Science in the Public Interest, based in Washington, DC, which had first started the study, checked the disclosure statements of authors of some hypertension guidelines published in 2004. Only one author reported a conflict of interest, but the centre’s further checking found that four other authors had received research funds from drug companies.
Guidelines are important because of the growing emphasis on evidence based medicine. They are often written by experienced doctors brought together by professional societies. Many evidence based recommendations rely on clinical trials.
Merrill Goozner, director of the Center for Science in the Public Interest’s Integrity in Science Project, told the BMJ that he was not surprised by the study’s findings and that he had cooperated with Nature. The centre had gathered data on 26 guidelines but had not completed the study. It had consequently given its information to Nature, which used the same methodology for its larger study.
Mr Goozner told the BMJ that many doctors did not disclose their drug industry connections, even when the guidelines or a journal required it. "There’s no standard journal policy," he said, "and no punishment [for not disclosing information]."
Although many experts in specialist fields consult with drug companies, Mr Goozner asserted that there were many independent experts to prepare guidelines. In writing guidelines, he told the BMJ, "It’s important to have those [experts] who have stood aside from the fray." Independent experts could be found in international organisations, at the Cochrane Collection, at the United States’ 125 medical schools, or at the US Office of Medical Applications of Research, he said.