Financial Conflicts of Interest among U.S. Physician Authors of 2020 Clinical Practice Guidelines: A Cross-Sectional Study

ABSTRACT Objective To evaluate the prevalence and accuracy of industry-related financial conflict of interest (COI) disclosures among U.S. physician guideline authors Design Cross-sectional study Setting Clinical practice guidelines published by the Council of Medical Specialty Societies in 2020 Participants U.S. physician guideline authors Main outcome measures Financial COI disclosures, both self-reported and determined using Open Payments data Results Among 270 U.S. physician authors of 20 clinical practice guidelines, 101 (37.4%) disclosed industry-related financial COIs, whereas 199 (73.7%) were found to have received payments from industry when accounting for payments disclosed through Open Payments. The median payments received by authors during the 3-year period was $27,451 (interquartile range [IQR], $1,385-$254,677). Comparing authors’ self-disclosures with Open Payments, 72 (26.7%) of the authors accurately disclosed their financial COIs, including 68 (25.2%) accurately disclosing no financial COIs and 4 (1.5%) accurately disclosing a financial COI. In contrast, 101 (37.4%) disclosed no financial COIs and were found to have received payments from industry, 23 (8.5%) disclosed a financial COI but had underreported payments received from industry, 14 (5.2%) disclosed a financial COI but had overreported payments received from industry, and 60 (22.2%) disclosed a financial COI but were found to have both underreported and overreported payments received from industry. We found that inaccurate COI disclosure was more frequent among professors compared to non-professors (81.9% vs. 63.5%; p<0.001) and among males compared to females (77.7% vs 64.8%; p=0.02). The accuracy of disclosures also varied among medical professional societies (p<0.001). Conclusions Financial relationships with industry are common among U.S. physician authors of clinical practice guidelines and are often not accurately disclosed. To ensure high-quality guidelines and unbiased recommendations, more effort is needed to minimize existing COIs and improve disclosure accuracy among panel members. What is already known on this topic Clinical practice guidelines are commonly used by physicians and influence patient care decisions Financial conflicts of interest among authors of clinical practice guidelines could compromise their integrity What this study adds Financial conflicts of interest are common among U.S. physician authors of clinical practice guidelines and often are not disclosed or disclosed inaccurately Although a significant proportion of the monetary value of industry payments received from guideline authors was associated with research activities through institutions, authors were more likely to have undisclosed or underreported COIs for direct payments Strength and limitations of this study Our study included a wide range of contemporary clinical practice guidelines from different professional societies, enhancing relevance and generalizability. We were limited to characterizing disclosures only for U.S. physicians. We only considered financial COIs with the pharmaceutical and medical device industry.