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 development.

JAMA. 2002;287:612-617
 
 
Author/Article Information

 
 
Author Affiliations: 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, Stelfox, Detsky.

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, Detsky.

Study supervision: Detsky.

Disclaimer: This study received no financial support from the pharmaceutical industry.

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 administration.