More conflict guidance needed for GI guideline authors, study finds

Roughly half of all gastroenterology guideline authors reported no industry relationships but authors suggested more guidance necessary, according to a research letter published in JAMA Internal Medicine.

Tyler R. Combs, BS, of the Center for Health Sciences at Oklahoma State University, and colleagues said a difference in self-reported conflicts and conflicts recorded in a public payments database might suggest a need for more guidance for these authors.

“Our investigation sought to understand and characterize the extent of relationships between authors of [clinical practice guidelines] in gastroenterology and their efforts to disclose those relationships to relevant stakeholders,” they wrote.

Per the researchers, the Institute of Medicine recommends that guideline development teams not include more than 50% authors who have financial relationships to disclose and further recommends that authors refrain from financial conflicts for 1 year following publication. While past studies have explored the role of conflicts in other specialties, Combs and colleagues wrote that no such analysis has been performed in gastroenterology.

To evaluate disclosure practices, researchers collected information from 15 gastroenterology-related practice guidelines published between 2014 and 2016. They retrieved information, including author names and disclosures from the American College of Gastroenterology website and collected individual payment data for each author from the Centers for Medicare and Medicaid Services OpenPayment database for the 6 months prior to and after publication of the guidelines. They then calculated medians and interquartile ranges for general and total payments received for each guideline.

Combs and colleagues identified 15 published guidelines comprising 83 total authors. Overall, 44 (53%) received industry payments. However, the median percentage of authors with disclosures per guideline was 50% (IQR, 50%–75%). They also found that the authors received a median total payment of $1,000 (IQR, $0–$39,938).

Additionally, investigators evaluated whether the authors did or did not disclose a conflict in their guideline, and if there was any evidence of a potential disclosure found in the OpenPayments database. They found that just 16 authors (19%) had disclosures or non-disclosures in the guideline that matched the information that was found on OpenPayments. Just 49 payments (34%) were both disclosed as conflicts and evidenced by public payment records.

Combs and colleagues wrote that more guidance might be needed for conflicts on future clinical practice guidelines.

“We recommend that the ACG draft new policies with specific expectations for [conflict of interest] disclosure among authors of gastroenterology [clinical practice guidelines], and that large-scale efforts be made to improve the comprehensiveness and reliability of the OpenPayments database.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.

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