Conflicts of interest noted among medical guideline writers

    More than half of the medical professionals who have worked on recent clinical practice guidelines for cardiovascular care have had self-reported conflicts of interest.

    Clinical practice guidelines translate research findings into standards for care and can affect reimbursement. Physicians are not obligated to follow them.

    A study published Monday in the Archives of Internal Medicine examined guidelines from the American College of Cardiology and the American Heart Association published from 2003-2008. It  found 56 percent of those who helped craft the guidelines reported ties to the medical industry. Those ties included serving on advisory boards, receiving research funding, owning stock or speaking on behalf of a medical company.

    Dr. James Kirkpatrick, assistant professor of medicine at the University of Pennsylvania and an author of the study, said any conflict of interest, whether it affects how guidelines are written or not, can hurt the credibility of all medical professionals.

    “Public confidence in the profession of medicine has been eroded somewhat,” Kirkpatrick said. “When we have conflicts of interest among physicians and people who produce guidelines, that potentially lowers public perception even more so.”

    Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, said he does not trust the guidelines for just those reasons. Conflict of interest rules have been tightening up in many areas recently, but Nissen said guideline writing is lagging.

    “Many medical schools have toughened up their standards, and no longer allow, for example, drug companies to give gifts to medical students and so on,” Nissen said. “The problem is that the area of guideline writing has fallen far behind other areas of medicine, and the authors of this article have brought our attention to this.”

    Research cited in the study shows doctors do not immediately implement guidelines as the standard of care; concern over author bias was cited as only a small reason why.



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