and discussions with staff or members of organizations involved with guideline development. It found no systematic information on the conflict of interest policies of groups that develop clinical practice guidelines. Reviews by Boyd and Bero (2006) and Boyd (2008) likewise found no systematic descriptions or assessments of these policies.

The availability, representativeness, and quality of the available information are limited in several important ways. As noted above, even if the developers of guidelines have conflict of interest policies, they may not refer to them in individual guideline documents. This in turn means that the summaries in the National Guideline Clearinghouse are likely to have no information either. A number of groups have recently revised aspects of their policies, and the committee is aware of other groups that are considering changes. In some cases, these changes may not be reflected on websites or in publications.

From the policies examined, the committee identified several variations in organization conflict of interest policies and procedures. They vary in the

  • information required for disclosure, including how detailed the information disclosed must be, how often disclosure is requested, and whether a panel member needs to explicitly state that he or she has no relationships to disclose;

  • management of disclosed information, including who reviews it and whether other panel members are told of conflicts;

  • procedures for managing the relationships disclosed, including limitations of participation by members with conflicts (such as serving as chair or cochair or voting);

  • provisions for public disclosure of conflict of interest policies, funding sources, and individual financial relationships;

  • procedures for managing relationships with companies that provide funding for guidelines development; and

  • assignment of explicit responsibility for monitoring whether institutional policies are followed.

The frequent lack of transparency of conflict of interest policies limits the ability of guideline readers to consider financial relationships and conflicts of interest as part of their assessment of the credibility of a set of guidelines. To give a sense of what readers of guidelines may encounter, Box 7-3 includes additional examples of the range of summary statements in the National Guideline Clearinghouse. (See also Box 7-2.)

The committee found few descriptions of the policies used to manage the relationship between guideline developers and industry for groups that accept industry funding for guideline development. One exception is the



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