interest policies and procedures and the sources and amounts of indirect or direct funding received for development of the guideline. In the exceptional situation in which avoidance of panel members with conflicts of interest is impossible because of the critical need for their expertise, then groups should

  • publicly document that they made a good-faith effort to find experts without conflicts of interest by issuing a public call for members and other recruitment measures;

  • appoint a chair without a conflict of interest;

  • limit members with conflicting interests to a distinct minority of the panel;

  • exclude individuals who have a fiduciary or promotional relationship with a company that makes a product that may be affected by the guidelines;

  • exclude panel members with conflicts from deliberating, drafting, or voting on specific recommendations; and

  • publicly disclose the relevant conflicts of interest of panel members.

RECOMMENDATION 7.2 Accrediting and certification bodies, health insurers, public agencies, and other similar organizations should encourage institutions that develop clinical practice guidelines to adopt conflict of interest policies consistent with the recommendations in this report. Three desirable steps are for

  • journals to require that all clinical practice guidelines accepted for publication describe (or provide an Internet link to) the developer’s conflict of interest policies, the sources and amounts of funding for the guideline, and the relevant financial interests of guideline panel members, if any;

  • the National Guideline Clearinghouse to require that all clinical practice guidelines accepted for posting describe (or provide an Internet link to) the developer’s conflict of interest policies, the sources and amounts of funding for development of the guideline, and the relevant financial interests of guideline panel members, if any; and

  • accrediting and certification organizations, public and private health plans, and similar groups to avoid using clinical practice guidelines for performance measures, coverage decisions, and similar purposes if the guideline developers do not follow the practices recommended in this report.

RECOMMENDATION 8.1 The boards of trustees or the equivalent governing bodies of institutions engaged in medical research, medical education, patient care, or practice guideline development should establish their



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