Appendix A
Literature Search Strategy for “Conflict of Interest”
This National Academies of Sciences, Engineering, and Medicine (the National Academies) committee recognizes the importance of considering conflicts of interest in contributing to and detracting from the public’s trust in the development of guidelines. To supplement previous evidence reviews and to identify additional resources for consideration, the committee conducted a focused literature review guided by the following preliminary questions:
- How are conflicts of interest managed in guideline development and/or in advisory committees? This may include but is not limited to the following:
- Evidence review
- Expert group or advisory committee formation
- Translation to recommendations or practice
- Project funding
- Are there any conflict-of-interest practices specific to nutrition or diet research and guidelines?
The main finding was significant variation of conflict-of-interest policies and practices across organizations and within guideline development processes, and limited empirical evidence linking these policies and practices to desired outcomes. This search was not intended to be a comprehensive review, but rather to identify relevant and recent publications for consideration.
SEARCH TERMS
A keyword search was run through Web of Science, PubMed, and Scopus. Keywords included conflict of interest, conflicts of interest, conflicting interest, competing interest, financial conflicts, commercial conflicts, funding, disclosure, guideline, guidelines, guidelines as topic, practice guidelines, committee, committees, advisory committee, committee membership, review literature, organizational policy, policy, policies, nutritional policy, and industry. The search was restricted to English language.
SCREENING
More than 800 unique articles were found, 62 of which met inclusion criteria of describing or managing conflicts of interest in the development of guidelines and advisory committees. The narrow focus of the search excluded conflicts of interest in areas not directly applicable (e.g., conflicts of interest in human subject research), while noting that many articles would be relevant to this National Academies committee’s second report. Two reviewers independently screened selected titles and abstracts for inclusion in the full-text review. An additional scan of the reference lists of relevant publications and previous Institute of Medicine publications (IOM, 2009, 2011) led to the identification and ad-hoc inclusion of additional articles. Some articles were determined not to be relevant and were excluded based on the full-text review. In total, 62 references were included and are listed below.
REFERENCES
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Bindslev, J. B., J. Schroll, P. C. Gotzsche, and A. Lundh. 2013. Underreporting of conflicts of interest in clinical practice guidelines: Cross sectional study. BMC Medical Ethics 14:19.
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Boyd, E. A., S. Lipton, and L. A. Bero. 2004. Implementation of financial disclosure policies to manage conflicts of interest. Health Affairs (Millwood) 23(2):206-214.
Boyd, E. A., E. A. Akl, M. Baumann, J. R. Curtis, M. J. Field, R. Jaeschke, M. Osborne, and H. J. Schunemann. 2012. Guideline funding and conflicts of interest: Article 4 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proceedings of the American Thoracic Society 9(5):234-242.
Campsall, P., K. Colizza, S. Straus, and H. T. Stelfox. 2016. Financial relationships between organizations that produce clinical practice guidelines and the biomedical industry: A cross-sectional study. PLoS Medicine 13(5):e1002029.
Chartres, N., A. Fabbri, and L. A. Bero. 2016. Association of industry sponsorship with outcomes of nutrition studies: A systematic review and meta-analysis. JAMA Internal Medicine 176(12):1769-1777.
Choudhry, N. K., H. T. Stelfox, and A. S. Detsky. 2002. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. Journal of the American Medical Association 287(5):612-617.
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Eccles, M. P., J. M. Grimshaw, P. Shekelle, H. J. Schunemann, and S. Woolf. 2012. Developing clinical practice guidelines: Target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implementation Science 7:60.
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George, J. N., S. K. Vesely, and S. H. Woolf. 2014. Conflicts of interest and clinical recommendations: Comparison of two concurrent clinical practice guidelines for primary immune thrombocytopenia developed by different methods. American Journal of Medical Quality 29(1):53-60.
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Gibbons, R. J., S. Smith, and E. Antman. 2003. American College of Cardiology/American Heart Association clinical practice guidelines: Part I. Where do they come from? Circulation 107(23):2979-2986.
Glodé, E. R. 2002. Advising under the influence?: Conflicts of interest among FDA advisory committee members. Food and Drug Law Journal 57(2):293-322.
Graham, T., P. Alderson, and T. Stokes. 2015. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: Qualitative study. PLoS ONE 10(3):e0122313.
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Guyatt, G., E. A. Akl, J. Hirsh, C. Kearon, M. Crowther, D. Gutterman, S. Z. Lewis, I. Nathanson, R. Jaeschke, and H. Schünemann. 2010. The vexing problem of guidelines and conflict of interest: A potential solution. Annals of Internal Medicine 152(11):738-741.
Haines, I. E., and I. N. Olver. 2008. Are self-regulation and declaration of conflict of interest still the benchmark for relationships between physicians and industry? Medical Journal of Australia 189(5):263-266.
Holloway, R. G., C. J. Mooney, T. S. D. Getchius, W. S. Edlund, and J. O. Miyasaki. 2008. Invited article: Conflicts of interest for authors of American Academy of Neurology clinical practice guidelines. Neurology 71(1):57-63.
IOM (Institute of Medicine). 2009. Conflict of interest in medical research, education, and practice. Washington, DC: The National Academies Press.
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Jones, D. J., A. N. Barkun, Y. Lu, R. Enns, P. Sinclair, M. Martel, I. Gralnek, M. Bardou, E. J. Kuipers, and J. Sung. 2012. Conflicts of interest ethics: Silencing expertise in the development of international clinical practice guidelines. Annals of Internal Medicine 156(11):809-816.
Kassirer, J. P. 2009. Commentary: Disclosure’s failings: What is the alternative? Academic Medicine 84(9):1180-1181.
Khalil, B., K. Aung, and I. A. Mansi. 2012. Reporting potential conflicts of interest among authors of professional medical societies’ guidelines. Southern Medical Journal 105(8):411-415.
Lesser, L. I., C. B. Ebbeling, M. Goozner, D. Wypij, and D. S. Ludwig. 2007. Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Medicine 4(1):e5.
MacKenzie, R., and W. Rogers. 2015. Potential conflict of interest and bias in the RACGP’s smoking cessation guidelines: Are GPs provided with the best advice on smoking cessation for their patients? Public Health Ethics 8(3):319-331.
Mendelson, T. B., M. Meltzer, E. G. Campbell, A. L. Caplan, and J. N. Kirkpatrick. 2011. Conflicts of interest in cardiovascular clinical practice guidelines. Archives of Internal Medicine 171(6):577-584.
Mühlhauser, I. 2010. From authority recommendations to fact-sheets—A future for guidelines. Diabetologia 53(11):2285-2288.
Mühlhauser, I., and G. Meyer. 2013. Evidence base in guideline generation in diabetes. Diabetologia 56(6):1201-1209.
Nathanson, I. 2013. Guidelines and conflicts: A new twist. Chest 144(4):1087-1089.
Neumann, I., E. A. Akl, M. Valdes, S. Bravo, S. Araos, V. Kairouz, H. Schünemann, and G. H. Guyatt. 2013a. Low anonymous voting compliance with the novel policy for managing conflicts of interest implemented in the 9th version of the American College of Chest Physicians antithrombotic guidelines. Chest 144(4):1111-1116.
Neumann, I., R. Karl, A. Rajpal, E. A. Akl, and G. H. Guyatt. 2013b. Experiences with a novel policy for managing conflicts of interest of guideline developers: A descriptive qualitative study. Chest 144(2):398-404.
Newton, A., F. Lloyd-Williams, H. Bromley, and S. Capewell. 2016. Food for thought? Potential conflicts of interest in academic experts advising government and charities on dietary policies. BMC Public Health 16(1):735.
Norris, S. L., H. K. Holmer, L. A. Ogden, and B. U. Burda. 2011. Conflict of interest in clinical practice guideline development: A systematic review. PLoS ONE 6(10):e25153.
Norris, S. L., H. K. Holmer, B. U. Burda, L. A. Ogden, and R. Fu. 2012a. Conflict of interest policies for organizations producing a large number of clinical practice guidelines. PLoS ONE 7(5):e37413.
Norris, S. L., H. K. Holmer, L. A. Ogden, S. S. Selph, and R. Fu. 2012b. Conflict of interest disclosures for clinical practice guidelines in the national guideline clearinghouse. PLoS ONE 7(11):e47343.
Norris, S. L., H. K. Holmer, L. A. Ogden, B. U. Burda, and R. Fu. 2013. Conflicts of interest among authors of clinical practice guidelines for glycemic control in type 2 diabetes mellitus. PLoS ONE 8(10):e75284.
Pham-Kanter, G. 2014. Revisiting financial conflicts of interest in FDA advisory committees. Milbank Quarterly 92(3):446-470.
Qaseem, A., F. Forland, F. Macbeth, G. Ollenschlager, S. Phillips, and P. van der Wees. 2012. Guidelines international network: Toward international standards for clinical practice guidelines. Annals of Internal Medicine 156(7):525-531.
Reardon, R., and S. Haldeman. 2008. Self-study of values, beliefs, and conflict of interest: The bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine 33(4 Suppl):S24-S32.
Ridker, P., and J. Torres. 2006. Reported outcomes in major cardiovascular clinical trials funded by for-profit and not-for-profit organizations: 2000–2005. Journal of the American Medical Association 295(19):2270-2274.
Riechelmann, R. P., L. Wang, A. O’Carroll, and M. K. Krzyzanowska. 2007. Disclosure of conflicts of interest by authors of clinical trials and editorials in oncology. Journal of Clinical Oncology 25(29):4642-4647.
Rosenberg-Yunger, Z. R. S., and A. M. Bayoumi. 2014. Transparency in Canadian public drug advisory committees. Health Policy 118(2):255-263.
Rowe, S., N. Alexander, F. M. Clydesdale, R. S. Applebaum, S. Atkinson, R. M. Black, J. T. Dwyer, E. Hentges, N. A. Higley, M. Lefevre, J. R. Lupton, S. A. Miller, D. L. Tancredi, C. M. Weaver, C. E. Woteki, and E. Wedral. 2009. Funding food science and nutrition research: Financial conflicts and scientific integrity. American Journal of Clinical Nutrition 89(5):1285-1291.
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Viswanathan, M., T. S. Carey, S. E. Belinson, E. Berliner, S. M. Chang, E. Graham, J.-M. Guise, S. Ip, M. A. Maglione, D. C. McCrory, M. McPheeters, S. J. Newberry, P. Sista, and C. M. White. 2014. A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest. Journal of Clinical Epidemiology 67(11):1229-1238.
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