Intellectual Conflicts of Interest Among Pulmonary and Critical Care Clinical Practice Guidelines

RATIONALE Conflicts of interest (COI) threaten the validity of clinical practice guidelines (CPGs). CPG-producing organizations, including the American Thoracic Society, have paid significant attention to COI and instituted changes to manage it more effectively in recent years. Although there is a large amount of evidence regarding the prevalence of financial COI, comparatively little is known about intellectual COI, and it has not been previously assessed among pulmonary and critical care CPGs. METHODS We retrospectively analyzed all CPGs published by pulmonary and critical care societies from the U.S, Canada, or Europe between January 1, 2018 and December 31, 2019. We searched prior publications of all chairs and authors in PubMed to identify intellectual COI -defined as prior i) authorship on a reviewed study within the CPG, ii) panel membership on a related CPG, or iii) publication of an editorial expressing an opinion on a topic addressed by the CPG, as these may all indicate a preexisting position that could conflict with an objective evaluation of the evidence. Our primary outcome measure was the median percentage of authors with an intellectual COI. We obtained additional information from the CPGs and organizations' websites on secondary outcome measures regarding management of intellectual COI including: use of GRADE methodology, inclusion of methodologists on the CPG panel, disclosure of nonfinancial COI, recusal due to intellectual COI, and inclusion of intellectual COI with the organization's COI policy. RESULTS We identified 26 CPGs published between January 1, 2018 and December 31, 2019. These CPGs included 465 authors and were produced by 7 different professional societies. Among all CPGs, a median of 58% [Interquartile range (IQR), 44% -74%] of authors had an intellectual COI, and a median of 100% [IQR, 79% -100%] of chairs or co-chairs had an intellectual COI. Although an intellectual COI was identified among at least one author in all CPGs, only 7 of 26 (27%) CPGs included a nonfinancial COI disclosure, and 0 CPGs required a panel member to be recused due to an intellectual COI. GRADE methodology was used in 25 (96%) CPGs, and methodologists were included in 19 (73%) CPGs. A total of 3 of 7 (43%) societies had a COI policy that specifically includes intellectual COI. CONCLUSION Among CPGs recently published by pulmonary and critical care societies, intellectual COI is highly prevalent, although it is infrequently disclosed by authors.

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