Relationships between authors of clinical practice guidelines and the pharmaceutical industry
Relationships between authors of clinical practice guidelines and the pharmaceutical industry
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DOI：
10.1001/jama.287.5.612
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发表时间：
2002-02-06
影响因子：
120.7
通讯作者：
Detsky, AS
中科院分区：
文献类型：
--
作者：
Choudhry, NK;Stelfox, HT;Detsky, AS
尽管文献中没有关于临床实践指南（CPG）作者潜在的经济利益冲突的数据，但据报道，医生和制药行业之间的联系不断增加。这些相互作用可能特别相关，因为 CPG 旨在影响大量医生的实践。 目的 量化 CPG 作者与制药行业之间相互作用的程度和性质。 设计、设置和参与者 对 192 位作者进行横断面调查，对 1991 年至 1999 年 7 月期间出版的北美和欧洲学会认可的关于常见成人疾病的 44 个 CPG 进行调查。 100 位作者 (52%) 提供了可用的答复，代表 44 名作者中的 37 名我们确定的不同 CPG。 主要结果指标 作者与药品制造商互动的性质和程度；在已发布的指南中披露关系；作者之间关于关系的事先讨论；关于作者自己的关系或同事的关系是否影响指南中的治疗建议的信念。结果 87% 的作者与制药行业有某种形式的互动。 58% 的人获得过进行研究的财政支持，38% 的人曾担任制药公司的员工或顾问。平均而言，CPG 作者与 10.5 家不同的公司进行了互动。总体而言，每个 CPG 平均有 81%（95% 置信区间，70% -92%）的作者存在交互。同样，我们研究中包含的 10 种疾病中的 7 种的所有 CPG 中至少有 1 位作者存在一定的相互作用。 59% 的作者与他们撰写的指南中考虑了其药物的公司有关系，而在这些作者中，96% 的人在指南创建过程之前就建立了关系。 55% 的受访者表示，他们参与的指导流程没有正式的流程来声明这些关系。在公布的 CPG 版本中，仅在 2 个案例中对个人作者与制药行业的个人财务往来做出了具体声明。 7% 的人认为他们自己与制药行业的关系影响了推荐，19% 的人认为他们的合著者的推荐受到他们的关系的影响。 结论 尽管这项调查的回复率较低，但 CPG 作者与制药行业之间似乎存在相当大的互动。我们的研究强调需要适当披露 CPG 作者的财务利益冲突，以及在 CPG 开发之前讨论这些冲突的正式流程。
Context Increasing contact has been reported between physicians and the pharmaceutical industry, although no data exist in the literature regarding potential financial conflicts of interest for authors of clinical practice guidelines (CPGs). These interactions may be particularly relevant since CPGs are designed to influence the practice of a large number of physicians.Objective To quantify the extent and nature of interactions between authors of CPGs and the pharmaceutical industry.Design, Setting, and Participants Cross-sectional survey of 192 authors of 44 CPGs endorsed by North American and European societies on common adult diseases published between 1991 and July 1999. One hundred authors (52%) provided usable responses representing 37 of 44 different CPGs that we identified.Main Outcome Measures Nature and extent of interactions of authors with drug manufacturers; disclosure of relationships in published guidelines; prior discussion among authors regarding relationships; beliefs regarding whether authors' own relationships or those of their colleagues influenced treatment recommendations in guidelines.Results Eighty-seven percent of authors had some form of interaction with the pharmaceutical industry. Fifty-eight percent had received financial support to perform research and 38% had served as employees or consultants for a pharmaceutical company. On average, CPG authors interacted with 10.5 different companies. Overall, an average of 81% (95% confidence interval, 70% -92%) of authors per CPG had interactions. Similarly, all of the CPGs for 7 of the 10 diseases included in our study had at least 1 author who had some interaction. Fifty-nine percent had relationships with companies whose drugs were considered in the guideline they authored, and of these authors, 96% had relationships that predated the guideline creation process. Fifty-five percent of respondents indicated that the guideline process with which they were involved had no formal process for declaring these relationships. In published versions of the CPGs, specific declarations regarding the personal financial interactions of individual authors with the pharmaceutical industry were made in only 2 cases. Seven percent thought that their own relationships with the pharmaceutical industry influenced the recommendations and 19% thought that their coauthors' recommendations were influenced by their relationships.Conclusions Although the response rate for this survey was low, there appears to be considerable interaction between CPG authors and the pharmaceutical industry. Our study highlights the need for appropriate disclosure of financial conflicts of interest for authors of CPGs and a formal process for discussing these conflicts prior to CPG development.