Pharmaceutical Payments to Authors of Dermatology Guidelines After Publication
Bibliographic record
Abstract
Clinical practice guidelines (CPGs) play increasingly vital and influential roles in clinical decision-making, optimization of patient care, and establishment and assessment care quality standards, and can affect insurance coverage.Oftentimes, CPG author expertise is sought by insurance and pharmaceutical companies, creating industry-physician relationships that may influence physicians' professional decisions.This is known as a conflict of interest (COI).Previous studies [1,2] provide strategies for reducing COI impact on guideline development (eg, restricting voting on final recommendations by committee members with COIs [1], requiring conflict-free periods prior to participation in guideline development [2]).In a June 2020 statement, the American Academy of Dermatology (AAD) announced revisions to its guideline development process, specifying that at least 51% of those authoring guidelines be nonconflicted (ie, no relevant financial COIs) and requiring nonconflicted authors to remain so for the entire guideline development process (ie, no new relevant industry relationships initiated during development) [3].CPG development ends when the draft guideline is approved by the AAD's Board of Directors and submitted for publication [4].The AAD requires disclosure of financial interests occurring within the 2-year period prior to CPG authorship [5].Although a prior study [6] demonstrated that former Food and Drug Administration committee members frequently received payments from the industry after the approval of dermatologic drugs, to our knowledge, there exists no similar exploration of industry payments to authors of recently published AAD guidelines.Post hoc general industry payments to AAD guideline authors in the period shortly following guideline publication (defined as publication year and 1 subsequent year) were analyzed.We reviewed all current AAD CPGs, including acne vulgaris, atopic dermatitis, keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma, same guideline authors), melanoma, psoriasis, and surgery, with publication dates spanning from 2013 to 2018.General payments made by companies to each CPG author were extracted and aggregated from publicly available data in the Centers for Medicare and Medicaid Services Open Payments database [7].The psoriasis guideline was excluded from further analysis because, unlike the other guidelines, it was published after the recent changes to the AAD's COI policy for guideline authors, and Open Payments data was only available through 2020.The Food and Drug Administration Orange [8] and Purple [9] Book databases were searched to identify companies (and subsidiaries, according to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.127 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.009 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.014 | 0.008 |
| Insufficient payload (model declined to judge) | 0.216 | 0.146 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".