High Prevalence of COIs Among Drafters of Neurology Guidelines

In its recently released Policy Announcements, the ACCME proposed that the commercial support of CME should only be allowed to continue in the setting of several changes. These proposed changes stipulated that educational needs and CME content should be specified by a "bona fide" organization that does not receive commercial support. Some (eg, Daniel Carlat) have suggested that these organizations may include those that draft core competencies (eg, the American Board of Psychiatry and Neurology) or, perhaps, practice guidelines. However, a responding question to that definition is Must the authors of these guidelines have no ties to industry? Which begs the follow-up, What is the extent of commercial ties among authors of practice guidelines?

This question is examined in the latest issue of Neurology, which reports potential conflicts of interest (COIs) among guideline authors for the American Academy of Neurology (AAN), the flagship organization of practicing neurologists.* The authors reported that, among 50 clinical-practice AAN guidelines examined, more than 90% had at least 1 author with a potential COI, and almost half of all authors had 3 or more COIs. The breakdown of the types of potential COIs is provided:

• Any, 77% (n = 272/351)
• Research, 45%
• Clinical practice, 42% (ie, practice of clinical procedure within last year)
• Personal income, 33% (eg, fees for consulting, speakers' bureaus, ad boards)
• Equity/stock options, 7%
• Expert testimony, 6%
• Fiduciary role, 3% (ie, officer, director, partner, or manager in company)
• Advocacy role, 2% (ie, payment for advocacy in nonprofit organization or government)
• Patent rights/royalties, 2%

* The AAN does not allow industry employees to participate in the guideline process or direct corporate sponsorship of the process; however, the AAN does accept corporate funding generally.