The Transparency Web Portal for
Clinical Practice Guidelines

Conflicts of Interest

Doctors need guidelines in order to provide treatment for their patients based on the best scientific evidence. Consequently, the guidelines should not be influenced by the commercial interests of pharmaceutical companies or the medical device industry.

The doctors who author these medical guidelines, however, often have ties to the industry in the form of consulting contracts, lecturer fees, and industry-financed studies. This results in conflicts of interest that not only need to be disclosed – their impact must also be minimized.

Or, to put it another way: Anyone who works for a manufacturer cannot evaluate the manufacturer’s products in guidelines.

The 5 Principles

International discussions have arrived at the following 5 principles for handling conflicts of interest (COI): ^1-4

• Disclosure and independent evaluation of COI
• Exclusion of persons with COI from guideline committees
• Detailed justification of exceptions (incl. suggestions for alternative members)
• Exceptionally invited persons with COI have to be physically absent during voting on relevant topics
• Online discussion of the guideline draft by the professional public and patients

1. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines, 2015
2. Institute of Medicine, Clinical Practice Guidelines We Can Trust, 2011
3. Sah S: Deep Professionalism: Charting a Path for Effective Conflict‑of‑Interest Management in Medicine. J Gen Intern Med 2024; DOI: 10.1007/s11606-024-08668-z
4. Chimonas S, Korenstein D: Managing conflicts of interest in healthcare: the new frontier. BMJ 2021;375:n2772; http://dx.doi.org/10.1136/bmj.n2772

The Project

The leitlinienwatch.de project evaluates guidelines in order to convey the expectations of doctors and society regarding the development of independent guidelines. The objective of leitlinienwatch.de is to provide examples of good guidelines and guidelines that need improvement.

In recent years, the Association of the Scientific Medical Societies in Germany (AWMF) has tightened its requirements for new guidelines. In addition to calling for the disclosure of conflicts of interest, it now supports excluding biased members from individual votes or from holding key positions. Many current guidelines still lag behind these standards, as this website documents. Our results on 67 German S3 guidelines enacted before 2016 were published in the journal BMC Medical Ethics.

Evaluation

Each guideline is evaluated by two reviewers, at least one of whom is a physician. Evaluations are based on the information published in the guidelines and the accompanying guideline report regarding the handling of conflicts of interest (www.awmf.org; www.escardio.org/Guidelines/Clinical-Practice-Guidelines).

We inform the scientific societies involved of each new evaluation and give them the opportunity to conduct a self-assessment and comment on the evaluation.

Evaluation criteria of GuidelineWatch