accept direct funding for guideline development from industry and generally to exclude individuals with conflicts of interest from guideline development panels. Because it may be impossible in some situations to obtain the needed expertise from individuals who have no conflicts, the recommendation also includes measures to limit the likelihood of undue influence if panels include members with conflicts of interest. These measures include requiring that chairs of guideline development panels have no conflicts of interest, limiting members with conflicts of interest to a small minority of the panel membership, and precluding such members from voting on topics in which they have a financial interest. The committee also calls for groups that develop guidelines to involve the public in attempts to identify experts without conflicts of interest, to make such efforts public, and to disclose publicly any conflicts of interest of those selected for membership on panels.

Recommendation 7.2 calls for organizations that have an interest in the use of evidence-based clinical practice guidelines to establish incentives to encourage the developers of guidelines to adopt the committee’s recommendations. For example, the National Guideline Clearinghouse could require that the guidelines that it posts include information about the sources of funding for a guideline, the sponsor’s conflict of interest policy, and the financial interests of the expert panel members. Similarly, public and private health plans and accreditation and certification bodies could avoid the use of clinical practice guidelines that lack information that allows users to identify conflicts of interest and assess the risks that they pose.

INSTITUTIONAL CONFLICTS OF INTEREST

Institutional conflicts of interest arise when an institution’s own financial interests or the interests of its senior officials pose risks to the integrity of the institution’s primary interests and missions. Institutional conflicts typically appear when research conducted within an institution could affect the value of equity that the institution holds in a company or the value of a patent that the institution licenses to a company. Institutional conflicts of interest have not received as much attention as individual conflicts of interest, but their consequences can also be damaging. If they are not properly identified and managed, institutional conflicts can undermine the work and reputation of an entire institution, including employees or members who are themselves strictly avoiding individual conflicts of interest.

Recommendation 8.1 calls for the boards of trustees of institutions to establish a conflict of interest committee to make judgments about institutional relationships with industry, including the relationships of senior officials. In their fiduciary role, members of the board oversee the long-term interests of the institution. They stand at a greater distance from the



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