Guideline controversy

Are clinical practice guidelines unduly influenced by the financial associations and competing interests of the experts who write them? The lead editorial of our Nov. 22 issue was stimulated by a news release we had received from the Canadian Diabetes Association (CDA) that criticized the Common Drug Review (CDR) for not approving for provincial formulary listing a new long-acting insulin that the CDA had recommended in its clinical-practice guidelines. According to the CDA, the CDR's judgment was uninformed because no clinical experts were involved. In reacting to this statement, we discovered that neither the CDA's nor the CDR's expert panels revealed or even discussed potential financial conflicts of interest among the experts who were making the recommendations.

In this trio of articles, the CDA and CDR explain their guideline and recommendation processes and their rationales for not revealing authors' conflicts of interest. We also asked Dave Davis to comment more generally on the problem of producing unbiased clinical practice guidelines and solutions that are being implemented to improve guideline quality.