Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 10;18(7):e0288349.
doi: 10.1371/journal.pone.0288349. eCollection 2023.

Intellectual conflicts of interest among cardiology and pulmonology clinical practice guidelines

J Henry Brems  1   2 , Taylor Wagner  2 , Julia Diamant  2 , Andrea E Davis  3 , Ellen Wright Clayton  4   5
Affiliations

Intellectual conflicts of interest among cardiology and pulmonology clinical practice guidelines

J Henry Brems et al. PLoS One. .

Abstract

Background: Intellectual conflicts of interest (COI), like financial COI, may threaten the validity and trustworthiness of clinical practice guidelines (CPGs). However, comparatively little is known about intellectual COI in CPGs. This study sought to estimate the prevalence of intellectual COI and corresponding management strategies among cardiology and pulmonology CPGs.

Methods: We conducted a retrospective document review of CPGs published by cardiology or pulmonology professional societies from the United States, Canada, or Europe from 2018 to 2019 available via the Emergency Care Research Institute, Guidelines International Network, or Medscape databases. We assessed the percentage of authors with an intellectual COI, defined as i) authorship on a study reviewed by the CPG, ii) authorship of a prior editorial related to a CPG recommendation, or iii) authorship of a prior related CPG. Management strategies assessed included use of GRADE methodology, inclusion of a methodologist, and recusals due to intellectual COI. Outcomes were assessed overall and compared between cardiology and pulmonology CPGs.

Results: Among the 39 CPGs identified (14 cardiology, 25 pulmonology), there were a total of 737 authors, of whom 473 (64%) had at least one intellectual COI. Among all CPGs, a median of 67% (Interquartile Range 50%-76%) of authors had at least one intellectual COI, and COI was more prevalent among cardiology compared with pulmonology CPGs (84% vs 57%, p<0.001). There was variable use of management strategies among the CPGs, including use of GRADE methodology (64% of CPGs), inclusion of a methodologist (49%), and recusals due to intellectual COI (0%).

Conclusion: Intellectual conflicts of interest appear to be highly prevalent and under-reported among cardiology and pulmonology CPGs, which may threaten their validity. Greater attention to and improved management of intellectual COI by CPG-producing organizations is needed.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Frequencies of intellectual COI by specialty.
Boxplot representing the percentage of authors identified with each sub-type of intellectual conflict of interest (iCOI) among (A) pulmonology and (B) cardiology CPGs.
Fig 2
Fig 2. Composition of guideline panels.
Boxplot of the percentage of authors with each role among all CPGs.
See this image and copyright information in PMC

References

    1. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999. Feb 20;318(7182):527–30. - PMC - PubMed
    1. Institute of Medicine (US), Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E. Clinical Practice Guidelines We Can Trust. National Academies Press (US); 2011. - PubMed
    1. Jefferson AA, Pearson SD. Conflict of Interest in Seminal Hepatitis C Virus and Cholesterol Management Guidelines. JAMA Intern Med. 2017. Mar 1;177(3):352. doi: 10.1001/jamainternmed.2016.8439 - DOI - PubMed
    1. Mitchell AP, Basch EM, Dusetzina SB. Financial Relationships With Industry Among National Comprehensive Cancer Network Guideline Authors. JAMA Oncol. 2016. Dec 1;2(12):1628. doi: 10.1001/jamaoncol.2016.2710 - DOI - PubMed
    1. Combs TR, Scott J, Jorski A, Heavener T, Vassar M. Evaluation of Industry Relationships Among Authors of Clinical Practice Guidelines in Gastroenterology. JAMA Intern Med. 2018. Dec;178(12):1711–2. doi: 10.1001/jamainternmed.2018.4730 - DOI - PMC - PubMed