Many clinical physicians have financial interests in private health companies (or organizations) including pharmaceutical companies. This fact has long been known. However, according to a recent study, most clinicians who draft practice guidelines have a financial interest in at least one private health company or organization. As a result, there is an inherent financial conflict of interest for these clinicians who draft practice guidelines. Among those doctors who have financial conflicts of interests, some fail to even disclose their conflict of interest yet actively participate in drafting important practice guidelines that directly effect patients. As a Chicago medical malpractice lawyer, I believe these conflicts of interest are extremely concerning. This is particularly true when the clinician fails to disclose their financial conflict of interest yet participates in drafting practice guidelines that further their own financial interests.
A practice guideline is a document designed to guide medical decisions and criteria regarding diagnosis, management, and treatment in particular areas of medicine. These documents often include a summary of consensus on best practices in healthcare. Doctors routinely rely upon these guidelines in formulating important medical decisions for their patients. For all these reasons, it is critical that these guidelines be completely safe, sound, and reliable.
According to another report recently presented at the VI International Conference on Patient Safety, "conflicts of interest (COI) among clinical practice guidelines (CPG) authors is an important source of bias for recommendations." The report authors observed funding of these clinical practice guideline authors by private practice organizations to be "common." The authors also found that "conflicts of interest among CPG authors is frequent and a significant percentage of CPGs do not provide disclosures."
Should a doctor who has a financial interest in a private pharmaceutical company or other private health organization be allowed to draft practice guidelines? If this were not allowed, we would be excluding a lot of brilliant doctors who have much to offer. But what if that same doctor is allowed to draft a practice guideline that directly impacts the company he or she has a financial interest in? As a medical malpractice lawyer, this is where I get uneasy. At minimum, any doctor who has a financial interest in a private company must be required to disclose this interest before drafting a practice guideline. This should be required regardless of whether the practice guideline may or may not impact the company in which the doctor has a financial interest. That way, there is no gray area. If a doctor refuses to disclose their financial interests, after being required to make such a disclosure, that doctor should be prohibited from having any involvement in drafting practice guidelines. To allow otherwise would invite biased and untrustworthy practice guidelines.
MedPage Today Website, Guideline Writers Often Don't Mention Conflicts Of Interest, October 11, 2011
Wikipedia, Medical Guideline, October 14, 2011.
Colloquium Cochrane Website, 19th Cochrane Colloguium, VI International Conference On Patient Safety, October 2011.