Additional Annals of Internal Medicine article for May 18, 2010, issue

Authors of a new article in Annals of Internal Medicine, the flagship journal of the American College of Physicians, offer a solution to the ongoing problem of conflict of interest in the development of clinical guidelines. The article is being published early online at www.annals.org.

Clinical guidelines influence medical practice. While most guidelines are evidence-based, composition of the panel reviewing the data may influence how evidence is interpreted. For this reason, panelists' conflicts of interest are an area of concern. Professional organizations have developed more rigorous regulation regarding conflict of interest, but issues still remain.

The executive committee of the American College of Chest Physicians' Antithrombotic Guidelines suggest a three-pronged strategy for resolving guideline conflict of interest. First, place equal emphasis on intellectual and financial conflicts and provide explicit criteria for both; second, assign a methodologist without important conflicts of interest to take primary responsibility for each chapter; and third, limit the role of experts with important financial or intellectual conflicts of interest so that they can collect and interpret evidence, but cannot develop the recommendation for a specific question.

"[Our] process for managing conflicts of interest in clinical practice guidelines offers an innovative strategy designed to reconcile the competing goals of incorporating expert insights and avoiding inappropriate influence of experts with financial or intellectual conflicts," wrote study lead author, Gordon Guyatt, MD, MSc, of McMaster University Health Sciences Centre, Hamilton, ON, Canada. "Other professional groups may find this approach, or variations of this approach, helpful in the development of their own clinical practice guidelines."

Provided by American College of Physicians