Undisclosed financial conflicts of interest in Canadian clinical guidelines on medications

Failure to disclose organizational financial conflicts of interest by producers of Canadian clinical practice guidelines on medications is widespread, pointing to the need for reform, a new research paper highlights in CMAJ (Canadian Medical Association Journal).

Most Canadian guideline producers who make recommendations on medications routinely receive industry funding, including from companies that produce drugs evaluated in the guidelines.

“We didn’t find any examples where guideline-producing organizations disclosed their organization’s industry funding in a guideline,” said Katharine Elder, a researcher at the Lady Davis Institute at the Jewish General Hospital, Montréal, Quebec, the study’s lead author.

“Reform is urgently needed to ensure that guidelines used in Canadian health care are free of commercial influences that may not reflect the best interests of patients,” says Dr. Brett Thombs, professor in the Department of Psychiatry, Lady Davis Institute at the Jewish General Hospital and McGill University. “Ideally, reform would come from guideline-producing organizations themselves, either out of a desire to better serve the public and society or through pressure from members.”

International directives for guideline producers recommend that they should avoid including committee members with financial conflicts of interest, not allow members with conflicts to influence recommendations, and not permit chairs and cochairs to have conflicts of interest. Most of the guidelines reviewed, however, included members with financial conflicts of interest, and all that reported on chairs or cochairs had one of these people with a financial conflict of interest.

“Our results suggest that these recommendations have largely been ignored by many Canadian disease or condition interest groups and medical professional societies that produce clinical practice guidelines,” added Dr. Thombs.

The study investigated the creation of Canadian clinical practice guidelines that included drug recommendations. They included 21 clinical practice guidelines, with 3 from government-supported organizations, 9 from disease or condition groups and 9 from medical professional societies. None of 3 government-sponsored guideline producers received industry funding, and none of their members disclosed financial conflicts of interest. Among the 18 disease or condition interest groups and medical professional societies, more than 90% reported on their websites receiving industry funding from producers of drugs being recommended. However, none disclosed this funding in a guideline.

Author competing interests:
Katharine Elder formerly worked as the administrator of the Canadian Task Force on Preventive Health Care (CTFPHC), which was the producer of one guideline included in the present study (cited as reference 41). Brett Thombs, Ainsley Moore and Sharon Straus are the chair, vice-chair and director of knowledge translation, respectively, for the CTFPHC. The present work was not commissioned or funded by the CTFPHC, and the authors participated in the study outside of their responsibilities with the CTFPHC. No other competing interests were declared.

“Reporting of financial conflicts of interest by Canadian clinical practice guideline producers” was published June 8, 2020.