Conflict of Interest: Clinical Practice Guidelines

April 1, 2007

In his column "Concerns About [Clinical] Practice Guidelines" or CPGs (Psychiatric Times, December 2006, page 28), Dr Michael A. Fauman addressed questions from his readers about a previous column, including the question, "How can physicians be sure that CPGs are free of bias from managed care and insurance companies?" He noted that CPGs are created through a process of expert consensus, and went on to say, "It is reasonable to question how these experts were selected and why they should be considered more qualified to draw conclusions from the research data."


In his column "Concerns About [Clinical] Practice Guidelines" or CPGs (Psychiatric Times, December 2006, page 28), Dr Michael A. Fauman addressed questions from his readers about a previous column, including the question, "How can physicians be sure that CPGs are free of bias from managed care and insurance companies?" He noted that CPGs are created through a process of expert consensus, and went on to say, "It is reasonable to question how these experts were selected and why they should be considered more qualified to draw conclusions from the research data."

Readers of Psychiatric Times might be interested to know that we, and some other members of the American Psychiatric Association (APA), have asked the APA to address another potential conflict of interest in the development of CPGs; namely, the inclusion (if not the predominance) on guidelines committees of APA members who have financial ties to the pharmaceutical industry.

In a letter we sent to the APA in September, we noted the increasing public concern about financial relationships between drug companies and influential physicians. We noted that judgments about a treatment guideline draw on a range of concerns well beyond that of the effectiveness of any given technology. These include psychology, sociology, economics, medical decision making, ethics, forensics, statistics, and epidemiology, among others. Accordingly, we suggested that physicians who might be potentially biased by their financial relationships not be included as voting members of committees on guidelines. There are other ways in which data and expert opinion about drug treatment could be provided to the committees.

We have asked the APA to go beyond simply requiring that members of guidelines committees and DSM-V committees disclose their financial relationships with industry; we have asked that potentially biased persons serve only in a consulting capacity but not as voting committee members. This would seem to be a definitive way to address concerns about objectivity.

David E. Ness, MD, Pittsburgh; Amy Brodkey, MD, Philadelphia; Frederick S. Sierles, MD, Chicago; Daniel Carlat, MD, Newburyport, Mass; G. Scott Waterman, MD, Burlington, Vt; Benjamin Crocker, MD, Portland, Me