[Financial contributions to guideline group members from industry: An analysis based on the US Open Payments database]

INTRODUCTION

Evidence-based clinical practice guidelines are one of the most important sources to inform clinical decision-making. They contain recommendations to support treatment decisions. These recommendations should be free from bias and should only aim to increase patient benefit. To ensure this, recommendations should be free from bias caused by conflicts of interest. When conflicts of interest exist, they should be completely transparent. The aim of this study was to analyze the payments from pharmaceutical and medical device industry to clinical practice guideline panel members (GPM). In addition, we assessed the completeness and accuracy of the GPMs' conflict of interest statements.

METHODS

A manual search for international guidelines was conducted on the website of the National Guideline Clearinghouse. We included all available clinical practice guidelines published in 2017. We extracted the names of all guideline group members and identified the payments they had received from industry over the four years preceding the publication using the "open payments" database.

RESULTS

In total, 81 guidelines were identified. We found data on payments for 543 out of 659 GPMs. For 34% of the GPMs, there was no declaration of individual conflicts of interest in either the guideline or related documents. The sum of payments across all guidelines to all GPMs was 10,844,938 USD. The average payment amounted to 19,972 USD and the median 1,227 USD. Sixty two percent of GPMs received at least 500 USD. Of these, 17% stated that they had no conflict of interest to declare.

DISCUSSION

The amount of industrial payments in some subject areas raises doubt about the independence of guideline recommendations. Stricter rules are needed to avoid and manage conflicts of interest of guideline authors. The analysis carried out indicates that conflict of interest involving GPMs is a considerable problem.

CONCLUSION

GPMs receive sizeable payments from industry. The payments are often inadequately disclosed or not disclosed at all. This threatens the objectivity of the recommendations in clinical practice guidelines.

Undisclosed conflicts of interest in German-language textbooks of anesthesiology, critical care, and emergency medicine

BACKGROUND

Medical textbooks are important throughout postgraduate internship, residency and fellowship programs but authors' conflicts of interest (COI) are rarely disclosed. In anesthesiology, two high-profile cases of research fraud/unethical publishing have previously been identified. This study evaluated whether anesthesiology textbooks in German include controversial recommendations on hydroxyethyl starch (HES) and whether authors had undisclosed COI.

METHODS

Forty-five anesthesiology, critical care, and emergency medicine electronic textbooks (January 2015-August 2017) were identified on the websites of German, Austrian, and Swiss publishers. Six textbooks were excluded (irrelevant content; compilation of peer-reviewed articles). Content on HES ('Kolloid', 'Hydroxyäthylstärke', 'Hydroxyethylstärke', 'HES', 'HAES') and COI ('Interessenkonflikt') was electronically searched; subject lists were manually searched. Recommendations on HES were analyzed in the context of indications/warnings/international guidelines. Potential COI for authors of controversial recommendations were searched on PubMed/EMBASE (January 2016-May 2018).

RESULTS

COI statements were absent in 38/39 textbooks (present for 1/553 authors; 0.2 %). Twelve textbooks did not discuss HES for volume resuscitation. HES was recommended in 13 textbooks; many recommendations were controversial (10/39 textbooks, 26 %; 25/553 authors, 5 %). Journal COI statements were available for 18/25 authors; 7 authors had financial/other COI, including 4/18 (22 %) with ties to HES manufacturers.

CONCLUSIONS

Recommendations on volume resuscitation with HES are highly controversial in German-language electronic textbooks; about one-quarter of relevant textbooks are inconsistent with regulatory authority or international guideline criteria. Undisclosed potential COI of textbook authors making controversial recommendations of HES were frequent, linking roughly one in five authors to the HES-producing industry. Against this background, COI statements must become part of standard textbook publication ethics.

[Patient attitudes and expectations towards conflicts of interest of attending physicians]

BACKGROUND

Patients can truly expect to be treated by their physicians without undue influences of secondary interests. It is not known what patients in Germany know about relationships between physicians and the pharmaceutical industry and if and how they want to be informed about these relationships.

METHOD

An information sheet explaining conflicts of interest and a 19-item questionnaire were distributed to 765 patients at various medical offices and hospitals in two German cities. 80 % (n=612) of the patients completed and returned the questionnaires anonymously.

RESULTS

65 % of the patients did not know of conflicts of interest (COI) doctors may have with the pharmaceutical industry. 74 % of the patients would like to know if their doctor had obtained any benefits through contacts with the pharmaceutical industry. 71 % agreed that a disclosure would increase their confidence, and 74 % wanted their physicians to declare COI verbally to them during a consultation. 40 % would prefer a doctor who is not receiving any benefits from the pharmaceutical industry. The desire for disclosure was significantly higher in patients who had an awareness of the problems of COI (OR 4.95; 95 % CI 3.33 - 7.35). However, 35 % of the patients trusted their attending physicians anyway and did not see a need for disclosure of any COI.

CONCLUSION

The majority of patients, but not all patients want to be informed about COI of their physicians. The best way to do this has yet to be determined.

[Conflict of interest in continuing medical education - Studies on certified CME courses]

OBJECTIVES

Although the problem of conflict of interest in medical education is discussed intensively, few valid data have been published on how to deal with the form, content, funding, sponsorship, and the influence of economic interests in continuing medical education (CME). Against this background, we carried out an analysis of data which had been documented for the purpose of certification by a German Medical Association. A central aim of the study was to obtain evidence of possible influences of economic interests on continuing medical education. Furthermore, strategies for quality assurance of CME contents and their implementation were to be examined.

METHODS

We analyzed all registration data for courses certified in the category D ("structured interactive CME via print media, online media and audiovisual media") by the Bavarian Chamber of Physicians in 2012. To measure the effects of conflict of interest, relationships between topics of training and variables relating to the alleged self-interest of the organizer/sponsor (for example, drug sales in a group of physicians) were statistically verified. These data were taken from the Bavarian Medical Statistics 2012 and the GKV-Arzneimittelschnellinformation.

RESULTS

In 2012, a total of 734 CME course offerings have been submitted for 51 medical specialties by 30 course suppliers in the Bavarian Medical Association. To ensure the neutrality of interests of the CME courses the course suppliers signed a cooperation treaty ensuring their compliance with defined behavior towards the Bavarian Medical Association concerning sponsorship. The correlation between course topics and drug data suggests that course suppliers tend to submit topics that are economically attractive to them. There was a significant correlation between the number of CME courses in a specific field and the sales from drug prescriptions issued by physicians in the respective field.

CONCLUSIONS

The results show that neutrality of interests regarding continuing medical education is difficult to achieve under the current framework for the organization, certification, and especially the funding of CME events in Germany. The cooperation agreement between the Bavarian Medical Association and training applicants is taken as an example of how legal certainty can be ensured. Based on the findings described below, suggestions and strategies to strengthen assessment expertise of course participants have been developed and elaborated.

[Nursing and industry relations: literature review and conflicts of interest survey]

BACKGROUND

Advanced competencies and tasks of nurses go along with an increasing interest of pharmaceutical companies and manufacturers in nurses as a marketing target.

OBJECTIVE

To identify nurses' attitudes, perceptions and behavior regarding industry and marketing strategies.

METHODS

1) Systematic literature search in Medline via PubMed and CINAHL for international studies on nurses' conflict of interests towards pharmaceutical companies; 2) analysis of a survey with PhD students from two Nursing Science doctoral programs.

RESULTS

The review including 16 publications published between 1999 and 2014 and the survey among 82 PhD students revealed comparable results. The majority of nurses already had contact with pharmaceutical companies. Nurses are often uncritical in their attitudes, and suggestibility is claimed to be low. The majority of nurses were not - or at least not sufficiently - provided with conflict of interest training, neither as part of their vocational training nor their continuing education.

CONCLUSION

Conflict of interest seems to be an important topic for nurses. Increasing relevance in the future underpins the need for making nurses more sensitive towards this issue, especially through professional training programs.

[Conflict of interest with industry--a survey of nurses in the field of wound care in Germany, Australia and Switzerland]

BACKGROUND

Nurses in the field of wound care are increasingly being courted by the wound industry.

OBJECTIVES

A survey regarding nurses' perceptions and participation in pharmaceutical marketing was conducted.

METHODS

Based on existing instruments, a standardized questionnaire (39 items, 5-point Likert scale) was developed. It was sent electronically and by mail to all nursing members of the Austrian Society for Vascular Care (ÖGvP), the German Wound Healing Society (DGfW e. V.) and the Swiss Association for Wound Care (SAfW).

RESULTS

178 nurses participated in the survey (75 % women; aged 27 - 70 years [median 45], 0 - 40 years [median 9] practice in the area of the wound care). Only about one fourth of the respondents (23,0 %) did not participate in pharmaceutical marketing last year. Generally small gifts were more frequently received than expensive gifts. Most of the nurses valued inexpensive gifts, educational gifts and gifts with patient benefit as appropriate. The majority of respondents consider themselves as less influenceable in decision making, compared to physicians.

CONCLUSIONS

The behavior and attitude of nurses are ambivalent. The occurrence of conflict of interest is partly justified by perceived patient benefit. Lack of knowledge about the topic and social desirability could be the cause of an uncritical attitude. For a more critical approach education and ethical standards are necessary.