Clinical guidelines are being increasingly produced to improve quality of care, but are vulnerable to bias.
Only 15% of guidelines on the National Health and Medical Research Council portal from the most prolific developers have published conflict of interest statements, and fewer detail the processes used to manage conflicts.
Comprehensive disclosure of conflicts is needed to safeguard the integrity of clinical guidelines and the medical profession.
Peak bodies and clinicians should seek to promote an improvement to current poor practice.
- 1. Choudry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002; 287: 612-617.
- 2. Lippi Bruni M, Nobilio L, Ugolini C. Economic incentives in general practice: the impact of pay-for-participation and pay-for-compliance programs on diabetes care. Health Policy 2009; 90: 140-148.
- 3. National Institute for Health and Clinical Excellence. Secondary prevention in primary and secondary care for patients following a myocardial infarction, Clinical Guideline 48. London: NICE, 2007. http://guidance.nice.org.uk/CG48 (accessed Aug 2011).
- 4. National Institute for Health and Clinical Excellence. Quality and Outcomes Framework menu of indicators. Indicator NM07 QOF ID: CHD14. London: NICE, 2010. http://www.nice.org.uk/aboutnice/qof/indicators_detail.jsp?summary=13071 (accessed Sep 2011).
- 5. British Medical Association. Focus on QOF payments 2011. London: BMA, 2007. http://www.bma.org.uk/employmentandcontracts/independent_contractors/quality_outcomes_framework/FocusQOF0207.jsp (accessed Aug 2011).
- 6. National Health and Medical Research Council. Clinical practice guidelines portal. Canberra: NHMRC, 2011. http://www.clinicalguidelines.gov.au/browse.php?pageType=3&Submit=Go (accessed Aug 2011).
- 7. Eichacker PQ, Natanson C, Danner RL. Surviving sepsis — practice guidelines, marketing campaigns, and Eli Lilly. N Engl J Med 2006; 355: 1640-1642.
- 8. Thompson DF. Understanding financial conflicts of interest. N Engl J Med 1993; 329: 573-576.
- 9. James A, Horton R, Collingridge D, et al. The Lancet’s policy on conflicts of interest — 2004. Lancet 2004; 363: 2-3.
- 10. Horton R. A statement by the editors of The Lancet. Lancet 2004: 363: 820-821.
- 11. Hardie EA, Critchley CR. Public perceptions of Australia’s doctors, hospitals and health care systems. Med J Aust 2008; 189: 210-214. <MJA full text>
- 12. Buchan H, Currie KC, Lourey EJ, Duggan GR. Australian clinical practice guidelines — a national study. Med J Aust 2010; 192: 490-494. <MJA full text>
- 13. The Royal Australian College of General Practitioners. Conflict of interest policy. Melbourne: RACGP, 2009. http://www.racgp.org.au/scriptcontent/poicy/policy_council/RACGPcouncilConflictofInterestformforCommittees.pdf (accessed Aug 2011).
- 14. Pfizer Australia. Partnerships. West Ryde: Pfizer Australia, 2010. http://pfizer.com.au/sites/au/about_pfizer_Australia/our_partnerships/Pages/TheHeartFoundation.aspx (accessed Aug 2011).
- 15. Heart Foundation. Information for professionals. Melbourne: Heart Foundation, 2011. http://www.heartfoundation.org.au/Information-for-professionals/pages/information-professionals.aspx (accessed Sep 2011).
- 16. Heart Foundation. Career development fellowship: instructions to applicants. 2011. Melbourne: Heart Foundation, 2011. http://www.heartfoundation.org.au/SiteCollectionDocuments/Career-development-fellowship-instructions.pdf (accessed Aug 2011).
- 17. Heart Foundation. Heart Foundation Pharmaceutical Roundtable members. Melbourne: Heart Foundation, 2011. http://www.heartfoundation.org.au/research/pharmaceutical-roundtable/Pages/current-members.aspx (accessed August 2010).
- 18. Rothman DJ, McDonald WJ, Berkowitz CD, et al. Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA 2009; 301: 1367-1372.
- 19. National Institutes of Health. A guide to preventing financial and non-financial conflicts of interest in human subjects research at NIH. Washington: NIH, 2007. http://ohsr.od.nih.gov/New/COI_GUIDE_02-07.pdf (accessed Sep 2011).
- 20. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. JAMA 2009; 301: 868-869.
- 21. National Institute for Health and Clinical Excellence. A code of practice for declaring and dealing with conflicts of interest. London: NICE, 2010. http://www.nice.org.uk/media/0B2/B6/DeclaringDealingConflictInterestOct08.pdf (accessed Aug 2011).
- 22. National Institute for Health and Clinical Excellence. A code of practice for declaring and dealing with conflicts of interest. London: NICE, 2010. http://www.nice.org.uk/media/0B2/B6/DeclaringDealingConflictInterestOct08.pdf (accessed Sep 2011).
- 23. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp30.pdf (accessed Aug 2011).
- 24. National Health and Medical Research Council. NHMRC standards and procedures for externally developed guidelines. Canberra: NHMRC, 2007. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/nh56.pdf (accessed Aug 2011).
- 25. Kendall T, McGoey L. Truth, disclosure and the influence of industry on the development of NICE guidelines: an interview with Tim Kendall. BioSocieties 2007; 2: 129-140.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.