Australian rheumatologists express concern about consensus statement bias

A shadow has fallen on recent evidence-based consensus statements for systemic sclerosis-associated ILD management which may have been developed with too much assistance from the pharmaceutical industry.

In Correspondence to The Lancet Rheumatology, American and Australian rheumatologists including Dr Samuel Whittle and Associate Professor Philip Robinson said they were concerned the development process may have been influenced by commercial interests.

While Boehringer Ingelheim had no role in designing the study, selecting the panelists or implementing the Delphi process, 61% of the authors had previous conflicts of interest with the company.

All participants were also offered honoraria from Boehringer Ingelheim.

The Correspondence said to restrict industry involvement, ACR for example recommends fewer than half of a guidelines committee have conflicts of interest, and industry funding is forbidden.

“Industry-funded consensus statements often serve as de facto guidelines; they should be held to similar standards,” the rheumatologists wrote.

They were particularly concerned about the “division of responsibility” between a professional medical writer and the authors.

“Although common in clinical trials, industry funded medical writers might exert undue influence on review articles and should not be allowed to be a pivotal part of creating ostensibly objective consensus statements.”

They also criticised the opportunity for Boehringer Ingelheim to review the manuscript for medical and scientific accuracy.

“Whether or not they exercised this right, the knowledge that it could occur might have influenced the authors or the medical writer. Furthermore, such oversight undermines the perceived objectivity of the project, both in the eyes of physicians and the public.”

They called on journals such as The Lancet Rheumatology to hold the line on integrity.

“Projects that allow industry-funded medical writers or industry review before publication should be discouraged, if not outright rejected. We hope that The Lancet Rheumatology will take a leadership role among rheumatology journals by endorsing these principles and encouraging others to do the same.”

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