Managing risk from conflicts of interest in guideline development committees

Evidence informed guidelines produced by global institutions, government bodies, and professional or charitable health organisations aim to promote best practice in public health and clinical care. Despite international standards relating to evidence assessment, transparency, and reducing bias,1234 the quality of these guidelines varies.5678

Conflicts of interest among committee members are an increasingly recognised contributor to bias in guideline recommendations.679 A conflict of interest is commonly defined as “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”10 For example, a conflict of interest arises if a guideline committee member is voting on a recommendation about taking statins for primary prevention to improve cardiovascular health (primary interest) and is receiving consulting fees from a statin manufacturer (secondary interest).

The risks associated with conflicts of interest depend on context and the nature and extent of the interest, making them hard to judge. Dietary guidelines have been particularly criticised for not having transparent or adequate conflict of interest processes and for having a high proportion of members with financial links to industry (box 1).615 A 2018 global review of 32 national dietary guidelines found that only three had conflict of interest policies and only four provided public transparency on committee members’ conflicts of interests.6 Using the example of nutrition, we argue that a risk based model that is adapted to the topic of the guideline is needed for assessing and managing the interests of committee members.