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      Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review

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          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.

          Article Highlights

          • 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.

          Related collections

          Most cited references52

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          Industry sponsorship and research outcome.

          Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have found that pharmaceutical-industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. A similar association between sponsorship and outcomes have been found for device studies, but the body of evidence is not as strong as for sponsorship of drug studies. This review is an update of a previous Cochrane review and includes empirical studies on the association between sponsorship and research outcome.
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            • Article: not found

            Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries.

            The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available.
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              • Record: found
              • Abstract: found
              • Article: not found

              Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts.

              Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed.
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                Author and article information

                Contributors
                Journal
                Mayo Clin Proc Innov Qual Outcomes
                Mayo Clin Proc Innov Qual Outcomes
                Mayo Clinic Proceedings: Innovations, Quality & Outcomes
                Elsevier
                2542-4548
                19 January 2021
                April 2021
                19 January 2021
                : 5
                : 2
                : 466-475
                Affiliations
                [a ]Department of Medicine, University of Toronto, Ontario, Canada
                [b ]Division of Gastroenterology, St. Michael’s Hospital, Toronto, Ontario, Canada
                [c ]Health Science Library, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
                [d ]Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
                [e ]Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, Ontario, Canada
                Author notes
                [] Correspondence: Address to Samir C. Grover, MD, MEd, FRCPC, Division of Gastroenterology, St. Michael’s Hospital, 30 Bond St, 16-036 Cardinal Carter Wing, Toronto, ON, Canada M5B 1W8. samir.grover@ 123456utoronto.ca
                Article
                S2542-4548(20)30200-9
                10.1016/j.mayocpiqo.2020.09.016
                8105509
                33997642
                72c1e208-43df-4530-bd0d-681c06394578
                © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Review

                cms-op, centers for medicare & medicaid services open payments,cpg, clinical practice guideline,fcoi, financial conflicts of interest

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