title: The vexing problem of guidelines and conflict of interest: a potential solution.
abstract: Issues of financial and intellectual conflict of interest in clinical practice guidelines have raised increasing concern. Professional organizations have responded by more rigorous regulation of conflict of interest. Nevertheless, tension remains between the competing goals of optimizing guideline quality by using the experience and insight of experts and ensuring that financial and intellectual conflicts of interest do not influence recommendations. The executive committee of the American College of Chest Physicians' Antithrombotic Guidelines has developed a strategy comprising 3 innovative aspects to address this tension: First, place equal emphasis on intellectual and financial conflicts and provide explicit criteria for both; second, a methodologist without important conflicts of interest should have primary responsibility for each chapter; and third, experts with important financial or intellectual conflicts of interest can collect and interpret evidence, but only panel members without important conflicts can be involved in developing the recommendation for a specific question. These strategies may help to achieve the benefits of expert input without conflicts of interest influencing recommendations.
authors.affiliation: McMaster University Health Sciences Centre, Henderson General Hospital, Hamilton, Ontario, Canada. guyatt@mcmaster
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.forename: Jack
authors.initials: J
authors.lastname: Hirsh
authors.forename: Clive
authors.initials: C
authors.lastname: Kearon
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
authors.forename: David
authors.initials: D
authors.lastname: Gutterman
authors.forename: Sandra Zelman
authors.initials: SZ
authors.lastname: Lewis
authors.forename: Ian
authors.initials: I
authors.lastname: Nathanson
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Holger
authors.initials: H
authors.lastname: Schünemann
mesh_terms: D016265:Conflict of Interest / Q000191:economics; D003253:Consultants; D030881:Disclosure; D004282:Documentation; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*