Conflict of Interest in Medical Research, Education, and Practice

TABLE 7-2 Number of Clinical Practice Guidelines in the National Guideline Clearinghouse by Selected Types of Sponsors, as of March 16, 2009

Type of Sponsor	Number of Guidelines
Medical specialty society (U.S. and other)	959
Professional association (U.S. and other; mostly nonphysician or mixed groups)	408
Government agency (non-U.S.)	214
Federal/state/local government agency	165
Nonprofit organization	142
Independent expert panel	97
Academic institution (U.S. and other)	98
Disease-specific society (U.S. and other)	202
Hospital/medical center (U.S. and other)	26
For-profit organization	21
Managed care organization	11
Total, all guidelines, all sponsors	2,343
NOTE: Some guidelines are developed collaboratively by more than one type of sponsor. For example, a guideline may list as developers one or more professional societies and one or more disease-specific societies. The National Guideline Clearinghouse (NGC) search option does not generate unduplicated counts by category of sponsor. The unduplicated count presented here was provided by NGC staff. Nineteen of the 26 guidelines from a hospital or medical center were submitted by a single institution. SOURCE: Personal communication, Mary Nix, Health Scientist Administrator, National Guideline Clearinghouse, March 22, 2009.

Public agencies also develop practice guidelines. U.S. federal and state agencies and public agencies from other countries accounted for more than 500 of the guidelines in the National Guideline Clearinghouse.

Some groups involved in guideline development have sought partners. For example, the American College of Cardiology and the American Heart Association have collaborated in their guideline development program since the 1980s (ACC/AHA, 2009). Several groups are investigating an international collaboration to develop guidelines for the care of respiratory diseases (personal communication, Holger Schunemann, M.D., Ph.D., chair, Department of Clinical Epidemiology and Biostatistics, McMaster University, February 19, 2009). Compared with the complexity of simply adding individuals with different professional and other backgrounds to a guideline development panel, the management of partnerships between and among agencies tends to be more complicated because each partner usually has, for example, its own policies and procedures. Nevertheless, the

Table of Contents

Front Matter R1-R22

Summary 1-22

1 Introduction 23-43

2 Principles for Identifying and Assessing Conflicts of Interest 44-61

3 Policies on Conflict of Interest: Overview and Evidence 62-96

4 Conflicts of Interest in Biomedical Research 97-121

5 Conflicts of Interest in Medical Education 122-165

6 Conflicts of Interest and Medical Practice 166-188

7 Conflicts of Interest and Development of Clinical Practice Guidelines 189-215

8 Institutional Conflicts of Interest 216-229

9 Role of Supporting Organizations 230-239

References 240-284

Appendix A: Study Activities 285-294

Appendix B: U.S. Public Health Service Regulations: Objectivity in Research (42 CFR 50) 295-301

Appendix C: Conflict of Interest in Four Professions: A Comparative Analysis 302-357

Appendix D: How Psychological Research Can Inform Policies for Dealing with Conflicts of Interest in Medicine 358-374

Appendix E: The Pathway from Idea to Regulatory Approval: Examples for Drug Development 375-383

Appendix F: Model for Broader Disclosure 384-391

Appendix G: Committee Biographies 392-400

Index 401-414