The Gastroenterological Society of Australia (GESA) says it is “open” to capping the number of clinicians with a financial conflict of interest (FCOI) permitted to sit on their guideline writing committees.

Their statement comes after US academics found that of 15 clinical guidelines in gastroenterology just over half of the 83 authors (53%) reported financial conflicts of interest.

And only 16 authors (19%) both disclosed financial conflicts in the guideline and had received payments according to OpenPayments database (OPD) or disclosed no FCOI and received no payments.

Writing in a research letter published in JAMA the researchers said industry payments to guideline authors were as high as $39 938 (USD).

The Institute of Medicine (US) currently recommends less than half of authors on guideline development teams have FCOIs and abstain from conflicts for one year after the guideline is published.

Speaking to the limbic Co-chair of GESA’s Research Committee Professor Paul Pavli, a senior specialist at Canberra Hospital’s gastroenterology and hepatology unit, said GESA does not currently impose a limit on the number of members with financial conflicts of interest who can sit on its guideline sub-committees.

But Professor Pavli said the society is willing to consider the idea, which appears to be designed to ensure there were enough members who were not conflicted, to outvote those who were, on issues that are controversial.

GESA requires guideline committee members to declare new conflicts at the start of every meeting and while these are recorded, they are not included in the guideline itself, Professor Pavli explains.

This is probably because “many members have lots of conflicts of interest and it may take up a lot of space”, he says.

But he says the issue is complex because industry partnerships often play a fundamental role in the funding of research and education across many diseases.

“It’s a difficult area. We [GESA] talk about conflicts of interest, but the College of Physicians (RACP) talk about ‘dualities of interest’.

“We do work with industry to further GP education activities, research activities. We work with industry because they provide us with support, so it’s not necessarily conflict of interest, there’s different aims.”

Policing conflicts is also problematic, he said.

An expert commentary accompanying the JAMA letter said problems with FCOI are widespread, ongoing and not being addressed because they mostly involve senior clinicians who hold positions of power in institutions and professional societies.

“Unfortunately…many of the professional societies that convene panels to develop practice guidelines have financial conflicts of interest with industry themselves, and members may have conflicts related to recommendations about when to perform diagnostic tests, procedures, or surgeries from which they derive income. Robust, objective, and unbiased CPGs support improvements in patient care; the best interests of patients are the paramount consideration,” the experts wrote.

A view point published in the same journal goes as far as recommending that a failure to declare significant FCOIs be treated as research misconduct and attract similar severe sanctions.

Professor Pavli said the idea was worth considering.

“I think to instil public confidence in the profession we should have the expectation that people declare all their interests and the greater the sums involved the more important it is they are declared,” he concluded.