The Argument for Caution When Judging Industry Payments to Dermatology Clinical Guideline Authors

The public should view with caution the recent findings that authors of dermatology clinical practice guidelines (CPGs) may be receiving industry payments that they don’t fully disclose, according to a statement from the American Academy of Dermatology (AAD).

JAMA Dermatology published a study last week that raised concerns over potential financial conflicts of interest among physicians who help create dermatology CPGs. AAD responded to the study, and its president, Henry W. Lim, MD, FAAD, said that dermatologists who author guidelines are the experts in their field, and as such they often engage with companies on the cutting edge of research.

“In evaluating potential conflicts of interest among guidelines authors, the AAD does not consider research activities to be conflicts, as these activities are vital in advancing clinical knowledge and fueling dermatologic innovation,” Lim explained.

The study, and AAD, both noted that it was not clear how, or if, these industry payments influenced the physicians involved in the development of dermatology guidelines, and the study only assessed if the payments were relevant if the company made products related to the guideline. However, those physician relationships could be unrelated.

In an editorial that accompanied the study, Kenneth A. Katz, MD, MSc, MSCE, of Kaiser Permanente, explained that the question of industry ties among authors of CPGs is important, because “CPGs influence decision making by physicians, patients, and insurers.”

However, Katz raises 3 questions:

1. Are the results valid? It’s not clear, he determined based on the literature search, the determination of the relevance of a manufacturer’s products to a CPG, and the version of regulations cited in the study.
2. Does it matter if CPG authors received payments? The study doesn’t address the question, although Katz said that the answer is likely “yes.”
3. What should be done? The study authors urged increased transparency and enforcement of payment policies and procedures.

“The AAD stands by the strength and accuracy of its clinical guidelines, as well as the regulations in place to minimize the influence of potential conflicts of interest on the guidelines process,” Lim said. “While we maintain the guidelines studied in this paper were created in compliance with those regulations, we take seriously this issue, and continue to evaluate and refine our guidelines process to address both real and perceived potential conflicts of interest.”