Conflicts of interest in guideline development: the NHMRC responds

Guidelines help doctors decide on the best way to treat patients. Jocelyn Augustino/FEMA News Photo

TRANSPARENCY AND MEDICINE – A series examining issues from ethics to the evidence in evidence-based medicine, the influence of medical journals to the role of Big Pharma in our present and future health.

Today Elim Papadakis from the National Health and Medical Research Council discusses changes in the Council’s conflict of interest policies.

The National Health and Medical Research Council (NHMRC) is developing new tools and practices to enhance conflict of interest awareness and management in the development of guidelines. These guidelines help doctors decide on the best way to treat patients.

The new tools will help all guideline developers to manage conflicts from the start of their projects.

Developing thorough public consultation

We recently conducted extensive public consultation on draft policies for Identifying and Managing Conflicts of Interest in relation to NHMRC Committees and Working Groups developing guidelines. The draft policies were considered by the NHMRC Council and will shortly be available through our website.

Under the new policy, all NHMRC approved guidelines will meet rigorous criteria for managing and reporting conflicts of interest.

It’s important to highlight that most Australian clinical guideline developers don’t seek NHMRC approval, although we do provide access to their guidelines through the NHMRC clinical practice guidelines portal as a service to clinicians, policy makers and developers of new guidelines.

The recent series on transparency and medicine on this website highlights the critical importance of managing both financial and non-financial conflicts of interest.

But the article about conflicts of interest among people developing clinical guidelines does not differentiate between NHMRC approved guidelines compared to those not approved by us but hosted on our portal.

We acknowledge that many of the guidelines not approved by NHMRC but hosted on the portal may not have been subjected to rigorous consideration of conflicts of interest. Clinicians and the public should exercise careful judgement when using them for this reason.

Recent changes

Since July 2011, our standards have made it mandatory for guideline developers who seek NHMRC approval to publish:

  • all sources of funding for the guideline;

  • a complete list of all the people involved, including professions, organisational affiliations and roles in the guideline development process, and;

  • how potential competing interests are identified, managed and documented.

A competing interest declaration must also be completed by each member of the guideline development group.

The new principles and practices will encourage more rigorous management of conflicts for people developing clinical guidelines. It’s now up to guideline developers to adopt them.

Claire Pitham, Director, Strategic Communications at the NHMRC, helped in the preparation of this article.

This is the fourteenth part of Transparency and Medicine. You can read previous instalments by clicking the links below:

Part One: Power and duty: is the social contract in medicine still relevant?

Part Two: Big debts in small packages – the dangers of pens and post-it notes

Part Three: Show and tell: conflicts of interest undeclared for clinical guidelines

Part Four: Eminence or evidence? The ethics of using untested treatments

Part Five: Don’t show me the money: the dangers of non-financial conflicts

Part Six: Ghosts in the machine: better definition of author may stem bias

Part Seven: Clearing the air: why more retractions are good for science

Part Eight: Pharma’s influence over published clinical evidence

Part Nine: Insight into how pharma manipulates research evidence: a case study

Part Ten: Why data from published trials should be made public

Part Eleven: Open disclosure: why doctors should be honest about errors

Part Twelve: Reaching full and open disclosure for universities, medical schools and doctors

Part Thirteen: Ethics of accepting suppliers’ gifts in the business v medical world

Part Fifteen: Consumer input in Medicines Australia’s code of conduct review