and 6 of this report, it should be easier to find individuals who are free of conflicts of interest involving promotional relationships (e.g., participation in speakers bureaus). If groups conclude that participants with conflicts of interest are essential to provide the necessary expertise, they should demonstrate to the public that they have made a good faith but unsuccessful effort to find individuals with the required expertise and without conflicts of interest. They should also preclude individuals with conflicts of interest from chairing guideline development panels, restrict the number of individuals with conflicts of interest on panels to a distinct minority (e.g., to 25 to 30 percent of the membership), and prohibit members with conflicts of interest from drafting and deciding specific recommendations.

In addition to actions by the institutions directly involved in the development of guidelines, organizations with an interest in unbiased clinical practice guidelines can create incentives for groups that develop guidelines to adopt the recommendations presented in this report. The committee understands that the National Guideline Clearinghouse will be phasing in a requirement for the disclosure of conflicts of interest, but the committee recommends that it extend the requirement to include the disclosure of funding and policy information, consistent with Recommendation 7.1. It would also be desirable for the clearinghouse or some other entity to begin substantive assessments of the quality of clinical practice guidelines.

RECOMMENDATION 7.2 Accrediting and certification bodies, health insurers, public agencies, and other similar organizations should encourage institutions that develop clinical practice guidelines to adopt conflict of interest policies consistent with the recommendations in this report. Three desirable steps are for

  • journals to require that all clinical practice guidelines accepted for publication describe (or provide an Internet link to) the developer’s conflict of interest policies, the sources and amounts of funding for the guideline, and the relevant financial interests of guideline panel members, if any;

  • the National Guideline Clearinghouse to require that all clinical practice guidelines accepted for posting describe (or provide an Internet link to) the developer’s conflict of interest policies, the sources and amounts of funding for development of the guideline, and the relevant financial interests of guideline panel members, if any; and

  • accrediting and certification organizations, public and private health plans, and similar groups to avoid using clinical practice guidelines for performance measures, coverage decisions, and similar purposes if the guideline developers do not follow the practices recommended in this report.



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