Nondisclosure of Financial Interest in Clinical Practice Guideline Development: An Intractable Problem?

This week in PLOS Medicine, Stelfox and colleagues [1] report that only half of a large sample of clinical practice guidelines included financial disclosure statements for committee members (51%). They were studying 290 national or international practice guidelines for medical professionals published by 95 organizations in the United States National Guideline Clearinghouse in 2012. That’s about the same rate that Taylor and Giles found in 2004 [2] and Norris and colleagues found in 2010 [3]. There may be even less transparency across the whole spectrum of clinical practice guidelines. The National Guideline Clearinghouse includes a selected group, all published in English. It’s hard to know how reflective those are of guidelines generally. In the late 1990s, when Grilli and colleagues studied guidelines identified via MEDLINE, they found that 67% did not report any description at all of the professionals involved in developing the guidelines [4]. A 2013 study of Danish specialty societies found that only one out of 45 guidelines disclosed financial interests the authors identified from an official national disclosure list [5], and a 2015 study of primary care guidelines found no statements about conflicts of interest in 69% [6]. When guideline recommendations are controversial—and that’s often—suspicion quickly turns to financial conflicts of interest. The perception of conflicts can call the reliability of a recommendation into question, and even more so if there was no disclosure. This new study adds fuel to those concerns. Stelfox and colleagues found that organizations with weaker policies on financial conflicts tended to make more positive recommendations about the use of biomedical products.