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Conflict of Interest in Gastroenterology Guidelines: A Lack of Transparency


Shah, Raj MD1; Numan, Laith MD2; Chandar, Apoorva K. MD, MPH1; Maruggi, Chiara MD1; Alabdulwahhab, Motib MD1; Chauhan, Mahak MD2; Davitkov, Perica MD3; Falck-Ytter, Yngve MD3; Sultan, Shahnaz MD, MHSc4

doi: 10.14309/01.ajg.0000594140.95973.2f

1University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;

2University of Missouri, Kansas City, MO;

3Case Western Reserve University School of Medicine, Cleveland, OH;

4University of Minnesota, Minneapolis, MN.

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In 2011, the Institute of Medicine (IOM), now the National Academy of Medicine (NAM) published standards for developing clinical practice guidelines, highlighting the necessity of transparency and the importance of minimizing conflict of interest (COI) in guideline authors. We aimed to assess the prevalence of COI and transparency of reporting COI in gastroenterology guidelines.

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Guidelines using GRADE methodology from American Association for the Study of Liver Disease, American College of Gastroenterology, American Gastroenterology Association, and American Society of Gastrointestinal Endoscopy societies from 2013 to October 15, 2018, were abstracted. We reviewed each guideline to determine if COI information was provided and the prevalence of COI among guideline authors. We further categorized conflicts as “research/academic funding” (not directly paid to the individual) or “other.” This other category included disclosures such as speaker's bureau, stocks, consulting, advisory board, honoraria, non-research funding, and industry-sponsored continuing medical education activities. Funding from government or nonprofit organizations were excluded.

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A total of 78 guidelines were reviewed. Of these, only 11 (14.1%) provided no or vague information on COI; ten guidelines (12.8%) provided only general statements about COI without details informing the reader if they were present or not and one guideline did not report COI. Across the 78 guidelines, 823 authors were identified. When COI was examined at the individual guideline author level, 222/823 authors (27%) had reported COI. The total number of conflicts for all guidelines across all authors was 816 and the majority (79.5%) of them were reported as “other” conflicts such as speaker's bureau, consulting, advisory boards and honoraria.

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During 2013-2018, approximately 14% of Gastroenterology guidelines did not fully inform their readers about COI and about 1 in 4 gastroenterology guideline authors self-reported as having potential conflicts. As this is based on self-report, underreporting could possibly inflate this issue. We suggest that societies producing guidelines consider a more rigorous COI management process to mitigate the perceived risk of biased guidelines and be more transparent about reporting COI.

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