Managing conflicts of interest in the development of health guidelines
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- RE: Conflicts of interest must not mask clinical guidelines’ original sinAlain Braillon [MD, PhD]Posted on: 15 January 2021
- Posted on: (15 January 2021)Page navigation anchor for RE: Conflicts of interest must not mask clinical guidelines’ original sinRE: Conflicts of interest must not mask clinical guidelines’ original sin
- Alain Braillon [MD, PhD], previously senior consultant at the university hospital of Amiens, Amiens, France
Traversy and colleagues rightly called for improving disclosure and management of conflicts of interest (CoI) in the development of clinical guidelines.(1)
Certainly, the bar must be raised but the issue is firstly about the implementation of principles. Legal actions can be a lever. A French charity, Formindep, sued the Haute Autorité de Santé (National Health Authority) before the Conseil d’Etat (the Supreme Court for administrative matters) for clinical guidelines on Alzheimer’s and type 2 diabetes whose experts had obvious major CoI. Guidelines were cancelled but neither administrators nor experts were condemned. In 2018 Fordimed with Anticor, an anti-corruption organisation, sued experts who failed to disclose their direct links of interests with the industry.(2)
However, the original sin cannot be overlooked. Recommendations in guidelines are rarely supported by evidence from well-designed randomized controlled trials and grade A1 recommendations are the minority.(3) Accordingly, recommendations considerably vary among guidelines, even for simple practices.(4) I’m afraid most guidelines are an opportunity to hijack the Evidence Based Medicine paradigm and to promote opinions without control: in 2013, the National Guideline Clearinghouse included 471 guidelines for hypertension and 276 for stroke.
Last, IMHO, no guidelines should be issued if no tools for implementation are provided and if no indicators of relevant clinical outcomes are monitore...
Show MoreTraversy and colleagues rightly called for improving disclosure and management of conflicts of interest (CoI) in the development of clinical guidelines.(1)
Certainly, the bar must be raised but the issue is firstly about the implementation of principles. Legal actions can be a lever. A French charity, Formindep, sued the Haute Autorité de Santé (National Health Authority) before the Conseil d’Etat (the Supreme Court for administrative matters) for clinical guidelines on Alzheimer’s and type 2 diabetes whose experts had obvious major CoI. Guidelines were cancelled but neither administrators nor experts were condemned. In 2018 Fordimed with Anticor, an anti-corruption organisation, sued experts who failed to disclose their direct links of interests with the industry.(2)
However, the original sin cannot be overlooked. Recommendations in guidelines are rarely supported by evidence from well-designed randomized controlled trials and grade A1 recommendations are the minority.(3) Accordingly, recommendations considerably vary among guidelines, even for simple practices.(4) I’m afraid most guidelines are an opportunity to hijack the Evidence Based Medicine paradigm and to promote opinions without control: in 2013, the National Guideline Clearinghouse included 471 guidelines for hypertension and 276 for stroke.
Last, IMHO, no guidelines should be issued if no tools for implementation are provided and if no indicators of relevant clinical outcomes are monitored to assess their impact.
Show LessCompeting Interests: AB is among industry independent experts from Jeanne Lenzer’s list.(https://jeannelenzer.com/list-independent-experts)References
- 1 Gregory Traversy, Lianne Barnieh, Elie A. Akl, et al. Managing conflicts of interest in the development of health guidelines. CMAJ 2021;193:E49-E54.
- 2 Scheffer P. Taking legal action against improper disclosure of interests. BMJ. 2020;368:m206.
- 3 Brown RE, Welsh P, Logue J. Systematic review of clinical guidelines for lipid lowering in the secondary prevention of cardiovascular disease events. Open Heart 2020;7:e001396.
- 4 Braillon A. Screening and Surveillance for Barrett's Esophagus: When Will We Reach the Horizon? Am J Gastroenterol 2016;111:899-900.
- Posted on: (11 January 2021)Page navigation anchor for RE: Managing conflicts of interestRE: Managing conflicts of interest
- Rick Zabrodski [MD], Family Physician, Cummins School of Medicine
Might I suggest we start with the current Canada Food Guideline?
Competing Interests: Focus on treatment of the cause of chronic illness, not just the symptomReferences
- Gregory Traversy, Lianne Barnieh, Elie A. Akl, et al. Managing conflicts of interest in the development of health guidelines. CMAJ 2021;193:E49-E54.
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- Why is it important to carefully manage COIs in the development of guidelines?
- What approaches have been developed for managing COIs in guideline development?
- How can guideline developers overcome challenges that may arise when implementing the GIN principles?
- What tools are available to assist Canadian guideline developers?
- What important issues have not been addressed by the GIN principles?
- Conclusion
- Footnotes
- References
- Figures & Tables
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