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- Page navigation anchor for RE: Transparent Criteria Expose Potential Bias in Clinical GuidelinesRE: Transparent Criteria Expose Potential Bias in Clinical Guidelines
With these explicit criteria from the College of Family Physicians of Canada [1], family medicine continues to lead the way in improving the quality, relevance, and usefulness of clinical practice guidelines for practitioners and their patients.[2] The emphasis on transparency and full disclosure of funding sources will help expose potential bias. The American Academy of Family Physicians pioneered these principles in 1994 by publishing the first international call for explicit declaration of conflicts of interest in the development of clinical practice guidelines.[3]
1. Allan GM, Cauchon M, Katz A, Kuling PJ, Moore S, Scrimshaw C, Stalker P. Endorsement of clinical practice guidelines. Criteria from the College of Family Physicians of Canada. Can Fam Physician 2021;67:499-502. DOI: 10.46747/cfp.6707499
2. Phillips WR. General practice leads in transparency of clinical guidelines. Comment on Moore, Ainsley, et al. Financial conflict of interest among clinical practice guideline-producing organisations. British J General Practice 70.700 (2020): 530-531. Web. 30 Oct. 2020. DOI: 10.3399/bjgp20X713177
3. Phillips WR. Clinical policies: making conflicts of interest explicit. JAMA 1994; 272(19):1479. DOI:10.1001/jama.1994.03520190021010.
Competing Interests: None declared. - Page navigation anchor for RE: Endorsement of clinical practice guidelines: criteria from the College of Family Physicians of CanadaRE: Endorsement of clinical practice guidelines: criteria from the College of Family Physicians of Canada
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’s too bad that those criteria are not bolder when it comes to financial conflict of interest (FCOI).
There is good evidence linking FCOI 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 non-cancer 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 the lack of any data showing a significant change in the prevalence of the condition (3).
The College criteria rightly require the source of funding for the guidelines to be stated but are silent on the public disclosure of industry funding of the organization that commissioned the 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), b...
Show MoreCompeting Interests: In 2017-2020, Joel Lexchin received payments for being on a panel at the American Diabetes Association, for talks at the Toronto Reference Library, for writing a brief in 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 conflict-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.