Clearinghouse. The guidelines posted by the clearinghouse are summarized in a common format that includes headings for information about the source(s) of funding and about financial disclosures or conflicts of interest.2 Although the clearinghouse is the most comprehensive source of information on the funding of guideline development activities and on financial disclosures and conflicts of interest, its data have some significant limitations. The analysts who compile the guideline summaries primarily rely on source documents provided by the guideline sponsor, and those documents may be incomplete. For example, because the source documents are silent on the topic, “Not stated” entries for “financial relationships/conflict of interest” may be found in clearinghouse summaries of guidelines for groups such as the American College of Physicians and the U.S. Preventive Services Task Force. These two groups do, in fact, have a process of disclosing, evaluating, and managing conflicts of interest.3 Given these and other limitations in the clearinghouse database, the committee used information from the database on funding sources and disclosures with caution.

The guideline initiatives described above and other initiatives have gradually but not fully replaced less rigorous guideline development efforts that lacked formal procedures, clear reporting of the authors involved with and the methods used for the systematic review of the evidence, and explicit links between the recommendations and the supporting evidence. Shortcomings in the processes for the development and reporting of clinical practice guidelines persist. These shortcomings include the incomplete disclosures of the financial relationships of the participants and the funding sources and informal procedures, which increase the opportunity for undue influence and bias (see, e.g., Shaneyfelt et al. [1999], Burgers et al. [2003], Harpole et al. [2003], Hasenfeld and Shekelle [2003], Shiffman et al. [2003], Boluyt et al. [2005], Guyatt et al. [2006], Poitras et al. [2007], Nix [2008], and Nuckols et al. [2008]).

2

The criteria for the inclusion of a guideline in the clearinghouse relate to sponsorship, evidence of some kind of literature review, adoption of the guideline within the last 5 years, and print or online availability of the complete text of the guideline.

3

To cite one example of how such omissions may occur, when U.S. Preventive Services Task Force guidelines are published in journals that require disclosures, they include a statement (compare, e.g., the guidelines on screening for lipid disorders in children as published in Pediatrics at USPSTF [2007a] and as published online at USPSTF [2007b]). In contrast, guidelines presented on the agency’s website do not routinely include information about the group’s conflict of interest policies and procedures or about the authors’ financial relationships (see, e.g., guidelines on screening for sickle cell disease in newborns at USPSTF [2007c]). The processes for developing the guidelines were the same, but the information in the clearinghouse varies because the source documents varied in the information that they provided. A discussion of task force policies can be found online in the procedure manual, but the site does not highlight it (USPSTF, 2008).



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