Table 2.

Classification of conflict of interest and action taken in the American College of Physicians’ guidance for management of competing interests among guideline authors17

Level of CoIDefinitionManagement of CoI
HighAny active relationship (financial or otherwise) with a high-risk entity, which the CGC defines as an entity that has a direct financial stake in the clinical conclusions of a guideline or guidance statement.Option 1: participant discontinues association if they are willing and able to do so (eg sell off stock in a pharmaceutical company). Once inactive, high-level COIs downgraded to low-level as opportunity for direct financial benefit has been eliminated.
Option 2: if participant is unwilling or unable to release the interest, they are restricted from involvement in guideline development (participation in discussions, voting on recommendations and authorship).
Option 3: participant may resign from the committee.
ModerateMost frequently an intellectual interest that is clinically relevant to the guideline topic. Intellectual CoIs are previously formed conclusions that may leave a clinical guideline vulnerable to cognitive biases (eg confirmation bias or authority bias) and may result in indirect financial benefit related to career advancement.Partial restriction: may participate in discussions but restricted from voting and authorship (recognised as a non-author contributor in final document).
LowIntellectual interest only tangentially related to guideline topic or a previous high-level CoI which is now inactiveNo restrictions: may participate in discussions, serve as an author and vote on recommendations.
  • CGC = Clinical Guidelines Committee; CoI = conflict of interest.