Industry involvement in clinical practice guidelines

The College of Family Physicians of Canada (CFPC) is to be commended for developing criteria for the endorsement of clinical practice guidelines (CPGs),¹ but it is too bad that those criteria are not bolder when it comes to financial conflicts of interest (FCOIs).

There is good evidence linking FCOIs to biases in guidelines. One study that looked at industry involvement in the production of CPGs for opioid prescribing concluded that

the clinical practice guidelines for opioid prescribing for CNCP [chronic noncancer pain] from 2007 to 2013 were at risk of bias because of pervasive conflicts of interest with the pharmaceutical industry, and with a paucity of mechanisms to mitigate bias.²

Industry-sponsored guidelines about the diagnosis and treatment of infants with allergies to cow’s milk protein led to an increase in prescriptions of specialist formula milks in the United Kingdom for infants with cow’s milk protein allergy of nearly 500%, despite lack of any data showing a significant change in the prevalence of the condition.³

The CFPC’s criteria rightly require that the sources of funding for guidelines be stated, but are silent on the public disclosure of industry funding from organizations that commission guidelines. Among 18 Canadian disease or condition interest groups and medical professional societies that sponsored guidelines, 14 of 15 disclosed organizational funding from industry on their websites (3 did not disclose funding), but none disclosed this information in the CPGs themselves.⁴

The 2011 report from the Institute of Medicine (now the National Academy of Medicine) recommended that the chairs and co-chairs of CPG committees have no FCOIs and that committee members with FCOIs should represent no more than a minority of the committee.⁵ The CFPC’s criteria ignore those recommendations and even allow industry employees to be members of guideline committees provided there is an explanation about how FCOIs are managed.

Clinicians rely on CPGs for guidance when making treatment decisions for patients. In 2016, 8 of the 5 most cited articles across all science were medical guidelines, disease definitions, or disease statistics.⁶ Well-done, evidence-based CPGs enhance the clinical care that physicians deliver,^7,8 but the CFPC needs to recognize the corrosive effect of industry involvement in the generation of guidelines and take decisive action.

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