Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Conflicts of Interest Unreported in Oncology Guidelines

Key clinical point: The majority of authors of oncology clinical practice guidelines in Japan report receiving compensation from pharmaceutical companies, but conflict of interest disclosures remain underreported in the guidelines.

Major finding: Among 326 authors for six clinical practice guidelines, 255 (78.2%) disclosed payments from pharmaceutical companies in 2016, with 25.8% receiving over $10,000.

Study details: A retrospective cross-sectional analysis of 326 oncology guideline authors in Japan.

Disclosures: The study was funded by the Medical Governance Research Institute and the Waseda Chronicle. The authors reported financial affiliations with Taiho Pharmaceutical and Medical Network Systems.


Saito H et al. JAMA Netw Open. 2019 Apr 26. doi: 10.1001/jamanetworkopen.2019.2834.


One question that remains from the study by Hiroaki Saito, MD, and colleagues is the significance of the underreporting of clinical practice guidelines authors’ financial conflicts of interest.

The recommendations provided in clinical practice guidelines have major financial implications for numerous stakeholder groups, including clinicians, patients, drug manufacturers, and society. As Japan is the third largest pharmaceutical market worldwide, the quality of conflict of interest disclosures is important, the researchers wrote.

In 2011, the U.S. Institute of Medicine [now the National Academy of Medicine] published recommendations on the development of clinical practice guidelines, which have now become the international standards. Their recommendations include mandatory reporting of financial conflicts of interests for all members of the development group, minimizing authors with financial conflict of interests, and selecting chairpersons without any financial conflicts.

Recent studies have suggested the importance of author financial affiliations as certain drugs endorsed in clinical practice guidelines were found to be correlated with authors’ conflicts of interest. Leaders and stakeholders must address concerns related to underreporting of conflicts of interest to uphold public trust.

Philip B. Mitchell, AM, MBBS, MD, is associated with the School of Psychiatry at the University of New South Wales in Sydney. No conflicts of interest were reported. These comments are adapted from his editorial (JAMA Netw Open. 2019 Apr 26. doi: 10.1001/jamanetworkopen.2019.2840 ).