Conflicts of Interest Common Among ACC-AHA Practice Guideline Participants

This TCTMD article covers a 2011 study by Mendelson et al. (Archives of Internal Medicine) examining conflicts of interest among the 498 participants in ACC-AHA clinical practice guidelines developed between 2003 and 2008. Fifty-six percent of participants reported at least one commercial conflict. Among guideline chairs and co-chairs — those with the most influence over final recommendations — the rate was 81%.

The study catalogued 510 commercial companies mentioned in conflict disclosures across 17 guidelines. The conflict rate varied dramatically by guideline, from 13% to 87%, suggesting that the problem was not uniform but concentrated in certain clinical areas. The Institute of Medicine’s threshold for acceptable conflict prevalence on guideline committees is below 50%; the field was near that threshold even before the major reforms that followed.

The ACC and AHA responded by noting that major policy changes adopted in 2010 — after the study period — require chairs to be conflict-free, mandate that a majority of committee members be conflict-free, and prohibit conflicted members from voting on related issues. These reforms were substantive and were driven in part by exactly this kind of critical scrutiny.

The article quotes Steven Nissen of the Cleveland Clinic: “If we fail as a profession to police our process, the credibility of evidence-based medicine will suffer irreparable harm.” The candor of that framing is worth noting. Guidelines are the mechanism by which research translates into clinical practice. If the committees that write them are systematically influenced by the industry whose products they recommend, the evidence base and the guidelines become difficult to disentangle.

We rate the evidence moderate. This TCTMD coverage of the Mendelson et al. guideline conflict study — documenting 56% conflict prevalence among ACC-AHA guideline participants in 2003–2008 — provides important historical context for evaluating guideline credibility, particularly for Class II recommendations that rely heavily on expert opinion.