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LetterLetters

Industry involvement in clinical practice guidelines

Joel R. Lexchin
Canadian Family Physician October 2021, 67 (10) 721-724; DOI: https://doi.org/10.46747/cfp.6710721_3
Joel R. Lexchin
Toronto, Ont
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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.

Footnotes

  • Competing interests

    In 2017 to 2020, Dr Joel R. Lexchin received payments for being on a panel at the American Diabetes Association; for talks at the Toronto Reference Library; for writing a brief on an action for side effects of a drug for Michael F. Smith, Lawyer, and a second brief on the role of promotion in generating prescriptions for Goodmans LLP; and from the Canadian Institutes of Health Research for presenting at a workshop on conflicts of interest in clinical practice guidelines. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co, Ltd, for books he has written.

  • The opinions expressed in letters are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

  • Copyright © the College of Family Physicians of Canada

References

  1. 1.↵
    1. Allan GM,
    2. Aubrey-Bassler K,
    3. Cauchon M,
    4. Ivers NM,
    5. Katz A,
    6. Kirkwood J, et al.
    Endorsement of clinical practice guidelines. Criteria from the College of Family Physicians of Canada. Can Fam Physician 2021;67:499-502 (Eng), e169-73 (Fr).
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Spithoff S,
    2. Leece P,
    3. Sullivan F,
    4. Persaud N,
    5. Belesiotis P,
    6. Steiner L.
    Drivers of the opioid crisis: an appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing. PLoS One 2020;15(1):e0227045.
    OpenUrlPubMed
  3. 3.↵
    1. Van Tulleken C.
    Overdiagnosis and industry influence: how cow’s milk protein allergy is extending the reach of infant formula manufacturers. BMJ 2018;363:k5056.
    OpenUrlFREE Full Text
  4. 4.↵
    1. Elder K,
    2. Turner KA,
    3. Cosgrove L,
    4. Lexchin J,
    5. Shnier A,
    6. Moore A, et al.
    Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020;192(23):E617-25.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines;
    2. Graham R,
    3. Mancher M,
    4. Miller Wolman D,
    5. Greenfield S,
    6. Steinberg E
    , editors. Clinical practice guidelines we can trust. Washington, DC: National Academies Press (US); 2011.
  6. 6.↵
    1. Ioannidis JPA.
    Professional societies should abstain from authorship of guidelines and disease definition statements. Circ Cardiovasc Qual Outcomes 2018;11(10):e004889.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Lugtenberg M,
    2. Burgers JS,
    3. Westert GP.
    Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual Saf Health Care 2009;18(5):385-92.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Corriere MD,
    2. Minang LB,
    3. Sisson SD,
    4. Brancati FL,
    5. Kalyani RR.
    The use of clinical guidelines highlights ongoing educational gaps in physicians' knowledge and decision making related to diabetes. BMC Med Educ 2014;14:186.
    OpenUrl
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Canadian Family Physician: 67 (10)
Canadian Family Physician
Vol. 67, Issue 10
1 Oct 2021
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Industry involvement in clinical practice guidelines
Joel R. Lexchin
Canadian Family Physician Oct 2021, 67 (10) 721-724; DOI: 10.46747/cfp.6710721_3

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