Authors of Clinical Practice Guidelines and the Pharmaceutical
Niteesh K. Choudhry, MD, FRCPC; Henry
Thomas Stelfox, MD, FRCPC; Allan S. Detsky, MD, PhD, FRCPC
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
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).
Corresponding Author and Reprints: Allan S. Detsky,
MD, PhD, FRCPC, Mount Sinai Hospital, Room 427, 600 University Ave,
Toronto, Ontario, Canada M5G 1X5.
Author Contributions: Study concept and design: Choudhry,
Acquisition of data: Choudhry, Detsky.
Analysis and interpretation of data: Stelfox, Choudhry.
Drafting of the manuscript: Choudhry, Detsky.
Critical revision of the manuscript for important intellectual
content: Choudhry, Stelfox, Detsky.
Statistical expertise: Stelfox.
Obtained funding: Detsky.
Administrative, technical, or material support: Choudhry,
Study supervision: Detsky.
Disclaimer: This study received no financial support from the
Acknowledgment: We thank the guideline authors, in particular
those who responded to 2 surveys and those who participated in interviews,
for their assistance and honesty. We are also indebted to Darren Merker,
Kevin Lumb, Kevin Schwartz, Heather Smith-St. Kitts, and Kimberley
Britnell for their invaluable assistance with data collection and survey
Financial Disclosures: Drs Choudhry and Stelfox have attended
numerous Department of Medicine educational rounds sponsored by the
pharmaceutical industry. Dr Detsky has received honoraria for speeches,
consulting fees, and research grants from pharmaceutical