Journal ArticleDOI
Conflicts of interest and the quality of recommendations in clinical guidelines.
Lisa Cosgrove,Lisa Cosgrove,Harold J. Bursztajn,Deborah R. Erlich,Emily E. Wheeler,Allen F. Shaughnessy +5 more
Reads0
Chats0
TLDR
The prevalence of conflicts of interest among panel members was high and the quality of the evidence cited raises questions about the validity of the recommendations, which should be a priority for guideline development groups.Abstract:
Background
There is increasing concern that conflicts of interest affect the development process of clinical practice guidelines. We evaluated The American Psychiatric Association's Practice Guideline for the Treatment of Patients with Major Depressive Disorder to determine the existence of financial and intellectual conflicts of interest and examine their possible effects. We selected this guideline because of its influence on clinical practice and because this guideline recommends pharmacotherapy for all levels of depression, despite controversies over the evidence base.
Methods and Findings
We determined the number and type of financial conflicts of interest for members of the guideline development group as well as for the independent panel charged with mitigating any effect of these conflicts. We also quantified the potential for intellectual conflicts of interest. We examined the quality of references used to support recommendations, as well as the degree of congruence between the research results and the recommendations. Fewer than half (44.4%) of the studies supporting the recommendations met criteria for high quality. Over one-third (34.2%) of the cited research did not study outpatients with major depressive disorder, and 17.2% did not measure clinically relevant results. One-fifth (19.7%) of the references were not congruent with the recommendations. Financial ties to industry were disclosed by all members (100%) of the guideline development committee with members reporting a mean 20.5 relationships (range 9–33). The majority of the committee participated on pharmaceutical companies' speakers' bureaus. Members of the independent panel that reviewed the guidelines for bias had undeclared financial relationships. As a marker of intellectual conflict of interest, 9.1% of all cited research and 13% of references supporting the recommendations were co-authored by the six guideline developers.
Conclusions
The prevalence of conflicts of interest among panel members was high. The quality of the evidence cited raises questions about the validity of the recommendations. Attention to the quality of cited studies and to the risk of bias resulting from conflicts of interest should be a priority for guideline development groups.read more
Citations
More filters
Agency for Healthcare Research and Quality (AHRQ)
Steve Bhimji,Jesse Cole +1 more
TL;DR: An interactive integration self-assessment checklist with immediate feedback linked to guidance and access to the Academy Community, an online forum for peer-topeer networking and sharing.
Journal Article
Conflict of Interest in Medical Research, Education, and Practice
TL;DR: The Institute of Medicine’s Conflict of Interest in Medical Research, Education, and Practice makes an important contribution to the continuing debate about financial conflicts of interest in medicine and makes 16 recommendations for reforming medicine, some of which would require radical changes.
Journal ArticleDOI
Ensuring the integrity of clinical practice guidelines: a tool for protecting patients
TL;DR: A large expert working group is pulled together to offer a manifesto for clinical guidelines that aims to provide a set of guiding principles for medical practice in the rapidly changing environment.
Journal ArticleDOI
Systematic Review of Clinical Practice Guidelines for Failed Antidepressant Treatment Response in Major Depressive Disorder, Dysthymia, and Subthreshold Depression in Adults
Glenda MacQueen,Pasqualina Santaguida,Homa Keshavarz,Natalia Jaworska,Mitchell Levine,Joseph Beyene,Parminder Raina +6 more
TL;DR: Consistency and clarity in guidelines for second-line treatment of depression are important for clinicians but lacking in most current guidelines, which may reflect a paucity of primary studies upon which to base conclusions.
Journal ArticleDOI
Assessment of methodologic quality of randomized trials of interventional techniques: development of an interventional pain management specific instrument.
Laxmaiah Manchikanti,Joshua A Hirsch,Steven P. Cohen,James E. Heavner,Falco Fj,Sudhir Diwan,Mark V. Boswell,Candido Kd,Obi Onyewu,Jie Zhu,Nalini Sehgal,Alan D. Kaye,Ramsin M Benyamin,Standiford Helm,Vijay Singh,Sukdeb Datta,Salahadin Abdi,Paul J. Christo,Haroon Hameed,Mariam Hameed,Ri Cardo Vallejo,Vidyasagar Pampati,Gabor B. Racz,P. Prithvi Raj +23 more
TL;DR: A new comprehensive instrument to assess the methodological quality of randomized trials of interventional techniques is developed which is superior to Cochrane review methodology criteria in that it provides more extensive and specific information for interventional Techniques that will be useful in assessing the methodologic quality and bias of inter conventional techniques.
References
More filters
Journal ArticleDOI
Pharmacological interventions for somatoform disorders in adults.
Maria Kleinstäuber,Michael Witthöft,Andrés Steffanowski,Harm W.J. van Marwijk,Wolfgang Hiller,Michael J. Lambert +5 more
TL;DR: A systematic review and meta-analysis of placebo-controlled studies examined the efficacy and tolerability of different types of antidepressants, the combination of an antidepressant and an antipsychotic, antipsychotics alone, or natural products in adults with somatoform disorders in adults to improve optimal treatment decisions.
Journal ArticleDOI
Interventions for latent autoimmune diabetes (LADA) in adults.
TL;DR: Two studies show SU leading to earlier insulin dependence and a meta-analysis of four studies with considerable heterogeneity showed poorer metabolic control if SU is prescribed for patients with LADA compared to insulin.
Journal ArticleDOI
Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Silvio E. Inzucchi,Richard M. Bergenstal,John B. Buse,Michaela Diamant,Ele Ferrannini,Michael A. Nauck,Anne L. Peters,Apostolos Tsapas,Richard C. Wender,David R. Matthews,David R. Matthews,David R. Matthews +11 more
TL;DR: Properties of currently available glucose-lowering agents that may guide treatment choice in individual patients with type 2 diabetes mellitus are explored.
Journal ArticleDOI
An fMRI Investigation of Emotional Engagement in Moral Judgment
Joshua D. Greene,R. Brian Sommerville,Leigh E. Nystrom,John M. Darley,Jonathan D. Cohen,Jonathan D. Cohen +5 more
TL;DR: It is argued that moral dilemmas vary systematically in the extent to which they engage emotional processing and that these variations in emotional engagement influence moral judgment.
Journal ArticleDOI
Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Silvio E. Inzucchi,Richard M. Bergenstal,John B. Buse,Michaela Diamant,Ele Ferrannini,Michael A. Nauck,Anne L. Peters,Apostolos Tsapas,Richard C. Wender,David R. Matthews,David R. Matthews,David R. Matthews +11 more
TL;DR: This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below).