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Editor's Correspondence |

The Proactive Management of “Relationship With Industry” by ACC/AHA in the Creation of Our Cardiovascular Clinical Practice Guidelines—Reply

Todd Mendelson, MD, MBE; Michele Meltzer, MD, MBE; Eric G. Campbell, PhD; Arthur L. Caplan, PhD; James N. Kirkpatrick, MD
Arch Intern Med. 2011;171(17):1598-1600. doi:10.1001/archinternmed.2011.426.
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In reply

We applaud the attention the ACC and AHA give to conflicts of interest (COI). Few other organizations have been as forthcoming in addressing COI in the guidelines process. We agree with Drs Brindis and Sacco that the advent, publication, and acceptance of guidelines improve patient care, and the impetus for our research1 was not to deter guideline use.

We appreciate the difficulty organizations face in producing guidelines that garner the trust required to be effective. The adoption of the Council of Medical Specialty Societies (CMSS) policy by the ACC was an important step. However, if one extrapolates the logic of requiring that the chair and majority of guideline committee members be free of conflicts, one could imagine moving to a committee 100% free of COI, especially given our finding of a substantial pool of nonconflicted experts with guidelines experience. The counterargument is that excluding crucial experts will diminish the quality of guidelines. But why not ask these crucial individuals to choose between guideline-writing participation and industry relations? Divestiture of industry affiliation is required of key society leaders in the CMSS policy.2 The same could be applied to guidelines committees, which are no less important.

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Correspondence

September 26, 2011
Steven E. Nissen, MD
Arch Intern Med. 2011;171(17):1598-1600. doi:10.1001/archinternmed.2011.432.
September 26, 2011
Ralph G. Brindis, MD, MPH; Ralph L. Sacco, MS, MD
Arch Intern Med. 2011;171(17):1598-1600. doi:10.1001/archinternmed.2011.425.
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