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- Page navigation anchor for RE: government vs pharmaceutical conflict of interestRE: government vs pharmaceutical conflict of interest
I read this article with interest however noting that this topic has extensively studied and published already. In this study authors mentioned 3 government funded studies assessing them for financial conflicts of interest from the pharmaceutical companies. However, they have not addressed government sponsored members who are usually tasked by government to achieve certain goals while being paid by the government making the writers of guidelines in significant conflict of interest. This has not be well studied or addressed by the authors. Hence, the conclusion of this study may be misleading to suggest that government funded studies are bias free.
Competing Interests: None declared.References
- Katharine Elder, Kimberly A. Turner, Lisa Cosgrove, et al. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020;192:E617-E625.
- Page navigation anchor for RE: User of Canadian CPGs demands greater transparencyRE: User of Canadian CPGs demands greater transparency
The "Editor's comment" on this article ("Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study") concluded with this call to action: "Users of Canadian CPGs must demand greater transparency".
I demand greater transparency in how guidelines are produced. There, I've said it.
My demand for greater transparency will most certainly have no bearing on how guidelines are produced. Apart from ignoring a given guideline (which I already do), my voice as an end-user has no impact here.
Instead, I would challenge the editorial board of the CMAJ that this is their role. Guidelines which aren't published in reputable medical journals have limited impact, and the journals are the only ones who can set - and enforce - standards related to transparency in guideline production, as in any other area of medical research/publication. I challenge the CMAJ to turn down guidelines which do not transparently address real and perceived conflicts of interest (and this goes beyond financial conflicts). It is only you who can make a difference here - not us.
Competing Interests: I have a bias against practice guidelines in general, based on years of disillusionment with their biases, single-disease focus at the expense of the whole patient, and the way they drive standard of care discussions, among other factors. I have no other competing interests related to this response.References
- Katharine Elder, Kimberly A. Turner, Lisa Cosgrove, et al. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020;192:E617-E625.
- Page navigation anchor for RE: Transparent reporting of organizational financial conflicts of interest by clinical practice guideline producersRE: Transparent reporting of organizational financial conflicts of interest by clinical practice guideline producers
Our study reviewed whether Canadian clinical practice guideline (CPG) producers disclose industry funding to their organizations in their CPGs and if they describe procedures to manage organizational financial conflicts of interest. Dr. Nagpal and colleagues wrote that by limiting our review to a single CPG from each producer we failed to identify policies that Diabetes Canada has in place. They suggest that we should have inquired directly with the organization or referred to a different document for an overview of their CPG development process.
We did review the document Dr. Nagpal and colleagues cited, Chapter 1 of the 2018 Diabetes Canada CPGs.1 In that document, it is stated that individual expert, steering and committee member conflict of interest disclosures are posted online. That information, however, relates to individual disclosures of people who participated in guideline development, and we did report that in our article.2 As described in Appendix 5, 5 of 5 panel members of the Diabetes Canada CPG we reviewed3 disclosed that they had financial conflicts.
Our study focus, though, was on organizational conflicts of interest and whether guideline producers disclose that their organizations receive funding from manufacturers of the drugs they review. None of the 2018 Diabetes Canada CPG documents mention that Diabetes Canada receives funding from producers of drugs evaluated in their CPGs. There is no mention of any process to mitigate the influence o...
Show MoreCompeting Interests: All authors have completed the ICMJE uniform disclosure form. Ms. Elder declared that she formerly worked as the administrator of the Canadian Task Force on Preventive Health Care, which was the producer of one guideline included in the study. Drs. Thombs, Moore, and Straus disclosed that they are Chair, Vice-Chair, and Director of Knowledge Translation for the Task Force. The present work was not commissioned or funded by the Task Force, and authors participated in the study outside of their responsibilities with the Task Force. All other authors declared no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.References
- 1. Diabetes Canada Clinical Practice Guidelines Expert Committee; Houlden RL. Introduction. Can J Diabetes. 2018;42:S1-S5.
- 2. Elder K, Turner KA, Cosgrove L, Lexchin J, Shnier A, Moore A, et al. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ. 2020;192:E617-E625.
- 3. Stone JA, Houlden RL, Lin P, Udell JA, Verma S. Cardiovascular protection in people with diabetes. Can J Diabetes. 2018;42:S162-169.
- 4. Schünemann HJ, Al-Ansary LA, Forland F, Kersten S, Komulainen J, Kopp IB, et al. Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Ann Intern Med. 2015;163(7):548-553.
- Page navigation anchor for CPG development at Diabetes CanadaCPG development at Diabetes Canada
Diabetes Canada is a national health charity and advocacy organization that produces comprehensive clinical practice guidelines (CPGs) for the prevention and management of diabetes in adults and children. Diabetes Canada’s CPGs have been evaluated and highly commended for formulating recommendations consistent with evidence-based conclusions, for their guidelines on prevention and screening, and for their systematic methods for searching the evidence and formulating recommendations. 1,2
We read with interest the recent study by Elder and colleagues 3 that sought to assess the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members that were disclosed in the CPGs, and organizational procedures for managing financial conflicts of interest. While the study authors assessed the websites of the organizations, it does not appear that they contacted the developers of the CPGs directly to inquire about processes existing to mitigate the influence of industry-related financial conflicts of interest, which may not be publicly available online. Diabetes Canada has policies around gifts and sponsorship, and actively separates fund development activities from guideline development and pubic and professional education activities, which would have been described had an enquiry been received. Due to a recent complete website overhaul, some content was not available for these authors. In the near future, a...
Show MoreCompeting Interests: None declared.References
- Katharine Elder, Kimberly A. Turner, Lisa Cosgrove, et al. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020;192:E617-E625.
- 1. Bennett WL, Odelola OA, Wilson LM, et al. Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus: a systematic review. Ann Intern Med. 2012;156(1 Pt 1):27-36.
- 2. Diab M, Barhoosh HA, Daoudi B, et al. Prevention and screening recommendations in type 2 diabetes: Review and critical appraisal of clinical practice guidelines. Prim Care Diabetes. 2019;13(3):197-203.
- 3. Elder K, Turner KA, Cosgrove L, et al. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020;192:E617-E625.
- 4. Diabetes Canada Clinical Practice Guidelines Expert Committee, Houlden RL. Introduction. Can J Diabetes. 2018 Apr; 42 Suppl 1:S1-S5.