More Than Half of Physician Guideline Authors for Expensive Medications Have Undeclared Conflicts of Interest Interview with:

Samir C. Grover MD, MEd, FRCPC Division of Gastroenterology Program Director Division of Gastroenterology Education Program  University of Toronto

Dr. Grover

Samir C. Grover MD, MEd, FRCPC
Division of Gastroenterology Program Director
Division of Gastroenterology Education Program
University of Toronto What is the background for this study? What are the main findings?

Response: We know that physician-industry interactions are commonplace. Because of this, there has been a movement to make the presence of these relationships more transparent. For clinical practice guidelines, this is especially important as these documents are meant to be objectively created, evidence based, and intended to guide clinical practice.

The standard in the US come from the National Academy of Medicine report, “Clinical Practice Guidelines We Can Trust”, which suggests that guideline chairs should be free of conflicts of interest, less than half of the guideline committee should have conflicts, and that guideline panel members should declare conflicts transparently.

Other studies, however, have shown that some guidelines don’t adhere to this advice and have committee members who don’t disclose all conflicts. We thought to look at this topic among medications that generate the most revenue, hypothesizing that undeclared conflicts would be especially prevalent in this setting.

We found that, among 18 guidelines from 10 high revenue medications written by 160 authors, more than (57%) had a financial conflict of interest, meaning they received payments from pharmaceutical companies that make or market medications recommended in that guideline. About a quarter of authors also received, and didn’t disclose payments from one of these companies. Almost all the guidelines did not adhere to National Academy of Medicine standards. What should readers take away from your report?

Response: The main take away is that authors of guidelines for high grossing medications have substantial undeclared conflicts of interest.

While the societies that enforce these guidelines have rules similar to NAM standards about conflicts of interest among guideline committee members, they could verify proper declaration by checking committee members declarations against the national physician-industry interaction database, Open Payments. What recommendations do you have for future research as a result of this work?

Response: Future studies should look at the impact of these conflicts. For example, do guideline committee members with more conflicts tend to vote more positively for the recommendation of a drug?

Any disclosures? Rishad Khan has received research funding from Abbvie and Ferring Pharmaceuticals.

Samir Grover has received research funding from Janssen, AbbVie, and Allergan; consultant fees from AbbVie, Takeda, Janssen; and, has ownership shares in Volo Healthcare.


Khan R, Scaffidi MA, Rumman A, Grindal AW, Plener IS, Grover SC. Prevalence of Financial Conflicts of Interest Among Authors of Clinical Guidelines Related to High-Revenue Medications. JAMA Intern Med. Published online October 29, 2018. doi:10.1001/jamainternmed.2018.5106

Oct 30, 2018 @ 1:15 pm 

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