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Jacobs JW, Booth GS, Stephens LD, Adkins BD, Martin AA, Lundberg GD, Glover RT, Khan SS, Silver JK, Woo JS. Industry payments to American Society of Hematology Clinical Practice Guideline authors. Blood Adv 2024; 8:3549-3552. [PMID: 38569136 PMCID: PMC11261266 DOI: 10.1182/bloodadvances.2023012527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Laura D. Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA
| | - Brian D. Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amarilis A. Martin
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY
| | | | - Raeshun T. Glover
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Shazia S. Khan
- Department of Pathology, Yale School of Medicine, New Haven, CT
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Jennifer S. Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA
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Akl EA, Hakoum M, Khamis A, Khabsa J, Vassar M, Guyatt G. A framework is proposed for defining, categorizing, and assessing conflicts of interest in health research. J Clin Epidemiol 2022; 149:236-243. [PMID: 35697333 DOI: 10.1016/j.jclinepi.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We propose an operational definition of conflicts of interest (COI), a framework for categorizing interests, and an approach to assessing whether an interest qualifies as a COI. STUDY DESIGN AND SETTING We reviewed the literature and conducted methodological studies to inform the development of a draft framework for classifying interests. RESULTS We developed the following operational definition: "a conflict of interest exists when a past, current, or expected interest creates a significant risk of inappropriately influencing an individual's judgment, decision, or action when carrying out a specific duty". Interest refers to a benefit (e.g., money received from industry) or to an attribute of the individual (e.g., having specific religious beliefs). The proposed framework includes seven types of interests relating to individuals (direct financial benefit, benefit through professional status, intellectual, and personal) or their institution (direct financial benefit to the institution, benefit through increasing services provided by the institution, and nonfinancial). When assessing whether an interest qualifies as a COI, one could consider its relevance, nature (e.g., cash vs. educational support), magnitude, and recency. CONCLUSION The proposed operational definition and categorization framework may help journals, guideline organizations, professional societies, and healthcare institutions enhance transparency in health research.
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Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | | | - Assem Khamis
- Hull York Medical School, University of Hull, Hull, UK
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Matt Vassar
- Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Al-Kuraishy HM, Al-Gareeb AI, Naji MT. Statin therapy associated with decreased neuronal injury measured by serum S100β levels in patients with acute ischemic stroke. Int J Crit Illn Inj Sci 2021; 11:246-252. [PMID: 35070915 PMCID: PMC8725813 DOI: 10.4103/ijciis.ijciis_7_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Acute ischemic strokes (AIS) are a common cause of morbidity, mortality, and disability. The serum biomarker S100β correlates with poor neurological outcomes in the setting of AIS. This study describes the impact of statin treatment on S100β levels following AIS. Methods This was a prospective case-control study of AIS patients compared to healthy controls. Patients were stratified into three groups: (1) AIS patients on statin therapy, (2) AIS patients not on statin therapy, and (3) healthy controls. Demographics, clinical parameters, stroke risk scores (SRS), and S100β levels were recorded for all patients. Results Blood pressure, lipids, and SRS scores were higher in stroke versus control patients (all P < 0.05), and lower in Group I versus II (all P < 0.05). S100β levels were higher in stroke versus nonstroke patients (P = 0.001), and lower in Group I versus II (P = 0.001). Furthermore, patients on atorvastatin showed greater S100β reductions than those on rosuvastatin therapy (P = 0.01). Conclusion In acute stroke patients, statins therapy correlated with reductions in the neuronal injury biomarker S100β, with greater reductions observed for atorvastatin than rosuvastatin therapy.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Pharmacology, Toxicology and Medicine, College of Medicine Almustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Pharmacology, Toxicology and Medicine, College of Medicine Almustansiriya University, Baghdad, Iraq
| | - Marwa Thaier Naji
- Department of Pharmacology, Toxicology and Medicine, College of Medicine Almustansiriya University, Baghdad, Iraq
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Lu S, Luo X, Ni X, Li H, Meng M, Cai Y, Liu Y, Ren M, Sun Y, Chen Y. Reporting quality evaluation of the stroke clinical practice guidelines: a systematic review. Syst Rev 2021; 10:262. [PMID: 34593016 PMCID: PMC8485553 DOI: 10.1186/s13643-021-01805-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To analyze the effectiveness and quality of stroke clinical practice guidelines (CPGs) published in recent years in order to guide future guideline developers to develop better guidelines. PARTICIPANTS No patient involved METHOD: PubMed, China Biology Medicine (CBM), Wanfang, CNKI, and CPG-relevant websites were searched from January 2015 to December 2019 by two researchers independently. The RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was used to assess the reporting quality in terms of domains and items. Then, a subgroup analysis of the results was performed. PRIMARY AND SECONDARY OUTCOME MEASURES RIGHT checklist reporting rate RESULTS: A total of 66 CPGs were included. Twice as many CPGs were published internationally as were published in China. More than half were updated. Most CPGs are published in journals, developed by societies or associations, and were evidence-based grading. The average reporting rate for all included CPGs was 47.6%. Basic information got the highest (71.7% ± 19.7%) reporting rate, while review and quality assurance got the lowest (22.0% ± 24.6%). Then, a cluster analysis between countries, publishing channels, and institutions was performed. There were no statistically significant differences in the reporting quality on the CPGs between publishing countries (China vs. international), publishing channels (journals vs. websites), and institutions (associations vs. non-associations). CONCLUSIONS Current stroke CPGs reports are of low quality. We recommend that guideline developers improve the quality of reporting of key information and improve the management of conflicts of interest. We recommend that guideline developers consider the RIGHT checklist as an important tool for guideline development. TRIAL REGISTRATION https://doi.org/10.17605/OSF.IO/PBWUX .
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Affiliation(s)
- Shuya Lu
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 611731 People’s Republic of China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Xiaojia Ni
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 People’s Republic of China
| | - Haoxuan Li
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
| | - Miaomiao Meng
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
| | - Yefeng Cai
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 People’s Republic of China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Mengjuan Ren
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Yanrui Sun
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Institute of Health Data Science, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, 730000 People’s Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, 730000 Lanzhou, People’s Republic of China
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Tabatabavakili S, Khan R, Scaffidi MA, Gimpaya N, Lightfoot D, Grover SC. Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review. Mayo Clin Proc Innov Qual Outcomes 2021; 5:466-475. [PMID: 33997642 PMCID: PMC8105509 DOI: 10.1016/j.mayocpiqo.2020.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To systematically evaluate the prevalence of disclosed and undisclosed financial conflicts of interest (FCOI) among clinical practice guidelines (CPGs). Methods In this systematic review, we ascertained the prevalence and types of FCOI for CPGs from January 1, 1980, to March 3, 2019. The primary outcome was the prevalence of FCOI among authors of CPGs. FCOI disclosures were compared between medical subspecialties and societies producing CPGs. Results Among the 37 studies including 14,764 total guideline authors, 45% had at least one FCOI. The prevalence of FCOI per study ranged from 6% to 100%. More authors had FCOI involving general payments (39%) compared with research payments (29%). Oncology, neurology, and gastroenterology had the highest prevalence of FCOI compared with other medical specialties. Among the 8 studies that included the monetary values in US dollars of FCOI, average payments per author ranged from $578 to $242,300. Among the 10 studies that included data on undisclosed FCOI, 32% of authors had undisclosed industry payments. Conclusion There are numerous FCOI among authors of CPGs, many of which are undisclosed. Our study found a significant difference in FCOI prevalence based on types of FCOI and CPG sponsor society. Additional research is required to quantify the implications of FCOI on clinical judgment and patient care. Financial conflicts of interest (FCOI) may have an impact on the objectivity of clinical practice guidelines. Among the 37 studies included in this systematic review, 45% of the 14,764 guideline authors had an FCOI. Authors of oncology, neurology, and gastroenterology guidelines had higher prevalence of FCOI compared with other guidelines. Eight studies included monetary value of FCOI, which ranged from $578 to $242,300 per author. Little is known about the direct impact of FCOI on how authors of clinical practice guidelines vote on recommendations during guideline development.
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Affiliation(s)
- Sahar Tabatabavakili
- Department of Medicine, University of Toronto, Ontario, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rishad Khan
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada.,Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David Lightfoot
- Health Science Library, Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samir C Grover
- Department of Medicine, University of Toronto, Ontario, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Nejstgaard CH, Bero L, Hróbjartsson A, Jørgensen AW, Jørgensen KJ, Le M, Lundh A. Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: associations with recommendations. Cochrane Database Syst Rev 2020; 12:MR000040. [PMID: 33289919 PMCID: PMC8092573 DOI: 10.1002/14651858.mr000040.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Treatment and diagnostic recommendations are often made in clinical guidelines, reports from advisory committee meetings, opinion pieces such as editorials, and narrative reviews. Quite often, the authors or members of advisory committees have industry ties or particular specialty interests which may impact on which interventions are recommended. Similarly, clinical guidelines and narrative reviews may be funded by industry sources resulting in conflicts of interest. OBJECTIVES To investigate to what degree financial and non-financial conflicts of interest are associated with favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. SEARCH METHODS We searched PubMed, Embase, and the Cochrane Methodology Register for studies published up to February 2020. We also searched reference lists of included studies, Web of Science for studies citing the included studies, and grey literature sources. SELECTION CRITERIA We included studies comparing the association between conflicts of interest and favourable recommendations of drugs or devices (e.g. recommending a particular drug) in clinical guidelines, advisory committee reports, opinion pieces, or narrative reviews. DATA COLLECTION AND ANALYSIS Two review authors independently included studies, extracted data, and assessed risk of bias. When a meta-analysis was considered meaningful to synthesise our findings, we used random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs), with RR > 1 indicating that documents (e.g. clinical guidelines) with conflicts of interest more often had favourable recommendations. We analysed associations for financial and non-financial conflicts of interest separately, and analysed the four types of documents both separately (pre-planned analyses) and combined (post hoc analysis). MAIN RESULTS We included 21 studies analysing 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews. We received unpublished data from 11 studies; eight full data sets and three summary data sets. Fifteen studies had a risk of confounding, as they compared documents that may differ in other aspects than conflicts of interest (e.g. documents on different drugs used for different populations). The associations between financial conflicts of interest and favourable recommendations were: clinical guidelines, RR: 1.26, 95% CI: 0.93 to 1.69 (four studies of 86 clinical guidelines); advisory committee reports, RR: 1.20, 95% CI: 0.99 to 1.45 (four studies of 629 advisory committee reports); opinion pieces, RR: 2.62, 95% CI: 0.91 to 7.55 (four studies of 284 opinion pieces); and narrative reviews, RR: 1.20, 95% CI: 0.97 to 1.49 (four studies of 457 narrative reviews). An analysis combining all four document types supported these findings (RR: 1.26, 95% CI: 1.09 to 1.44). One study investigating specialty interests found that the association between including radiologist guideline authors and recommending routine breast cancer screening was RR: 2.10, 95% CI: 0.92 to 4.77 (12 clinical guidelines). AUTHORS' CONCLUSIONS We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.
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Affiliation(s)
- Camilla Hansen Nejstgaard
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado, Colorado, USA
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | | | | | - Mary Le
- Stasjonsgata Legekontor, Hokksund, Norway
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
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Stadler WM. No interest, no conflict. Cancer 2020; 126:3627-3628. [DOI: 10.1002/cncr.32995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Walter M. Stadler
- Section of Hematology and Oncology University of Chicago Chicago Illinois
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