More than one quarter (25.6%) of the authors writing clinical practice guidelines (CPGs) recommending high-priced medications failed to disclose relevant payments from drug companies, according to new research. 

Another study found payments disclosed in gastroenterology clinical guidelines often differed from those reported by the Centers for Medicare & Medicaid Services (CMS).

Rishad Khan, BSc, Division of Gastroenterology, St. Michael's Hospital, and Department of Medicine, University of Toronto, Ontario, Canada, and colleagues published their findings October 29 in a research letter in JAMA Internal Medicine.

US-based physician

They identified 18 CPGs published from 2013 through 2017 that made recommendations for 10 of the highest-priced medications in the United States. They then examined the disclosed and undisclosed payments by each drug's marketers to the 160 US-based physician authors and information from the CMS Open Payments website on payments pharmaceutical companies made to physicians.

Of the 160 authors, 50 (31.3%) declared payment from companies marketing the medication recommended in the guideline. An additional 41 authors (25.6%) received but did not disclose, payments from the marketers.

Among all authors, the average undeclared payment value was $522 (interquartile range [IQR], $0 – $40,444) from two companies (IQR, 0 – 4). Payments to physicians have been shown to affect clinical decisions in previous research.

Many Undisclosed Payments Were $10,000 or More

In an accompanying editor's note, Colette DeJong, MD, from the University of California, San Francisco School of Medicine, and Robert Steinbrook, MD, editor at large, JAMA Internal Medicine, point out that "many of the undisclosed payments were $10,000 or more."

None of the CPGs had complete written disclosures of all potential financial conflicts of interest (COI) under National Academy of Medicine standards, which also require appointing committee chairs or co-chairs with no conflicts of interest and limiting committee members with COI to a minority, Kahn, and colleagues found.

The study authors acknowledge that because they did not have access to guideline voting records, they could not determine when panel members with conflicts voted against medication or recused themselves from voting.

Example From Gastroenterology

A related research letter in the journal by Tyler R. Combs, BSc, from the Center for Health Sciences, Oklahoma State University at Tulsa, and colleagues, reports findings from a study on COI in gastroenterology guidelines. Previous studies have examined COI in dermatology, oncology, and otolaryngology.

The researchers included 15 CPGs with a total of 83 authors identified from the American College of Gastroenterology (ACG) website. Individual payment data was found using the 2014 to 2016 CMS Open Payments database (OPD).