In reply: Johnson's letter raises an important point about the influence of external agencies such as pharmaceutical companies in the development of clinical practice guidelines. Although our systematic review1 of 30 studies of clinician attitudes to clinical practice guidelines did not identify this issue as a major barrier, it is possible that the surveys used overlooked this concern. Conflict-of-interest statements and the source of funding for clinical practice guidelines and their development teams are not always published. In the AGREE2 questionnaire (a measurement instrument developed for clinical practice guidelines), reporting conflict of interest and source of funding is encouraged. The New Zealand Guideline Group has a policy of declaring conflicts of interest, and pharmaceutical industry representatives are not included in guideline development teams.3
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