The AAN's systematic review (SR) and guideline conflict of interest process is fairly straightforward. Once the Guideline Development Subcommittee (GDS) approves the topic, we assign a lead GDS facilitator, additional members from the GDS, and then search for individuals who can aid in the development of the SR.

All panel members must complete our conflict of interest (COI) form before any work is done on the panel. A sample COI form is found at this link and requests full disclosure in the following areas: financial disclosure (gifts, royalties, stipends, patents, honoraria), clinical procedures performed, research support (commercial, government, and academic), stock, stock options, and royalties, and legal proceedings. The forms are completed and submitted, reviewed by the lead facilitator, the AAN EBM consultant, and AAN staff. Upon approval of this group, the GDS leadership reviews the forms and ratifies the decision made by the aforementioned team or requests changes to the proposed author panel. 

As others in guideline development know, intellectual conflicts may be more difficult to identify. Below is an excerpt of a definition of intellectual conflicts from the IOM:¹

A person whose work or professional group fundamentally is jeopardized, or enhanced, by a guideline recommendation is said to have intellectual COI. Intellectual COI includes authoring a publication or acting as an investigator on a peer reviewed grant directly related to recommendations under consideration. 

The process that the AAN uses to best determine whether individuals have intellectual conflicts is to obtain their CV and review all of their professional work. Here we can see what grants they've received beyond the two year financial conflict of interest period, academic appointments they've held, book chapters authored, and publications in journals. 

Are there different questions that you ask on your disclosure forms, or non-disclosure agreements? Do you have a more thorough process for identifying intellectual conflicts?

¹ IOM (Institute of Medicine). 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. Accessed March 23, 2011. pg 59.

John Hutchins, JD, is the associate general counsel of the AAN and general counsel of the AAN Foundation. Hutchins and colleagues published an article in Neurology® on March 6 detailing the AAN’s policies on pharmaceutical and device industry support¹. The article examines prevention and limitation of conflicts of interest related to relationships with industry, not only for continuing medical education offerings, Annual Meeting support, and serving as a volunteer on a committee within the AAN, but the AAN policies as they relate to guideline development. In addition to this comprehensive article, access the Neurology® podcast. Dr. Ted Burns, podcast editor, interviews Hutchins in more detail about the AAN’s policies as they relate to guideline development. The interview starts at 1:19 and ends at 9:50.

How does your organization manage conflicts of interest among your members and, specifically, your guideline authors? Our Monday, March 12, post will go into detail regarding the process for identifying panel members, reviewing disclosures, and appointing members to the writing groups.

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1 Neurology March 6, 2012vol. 78 no. 10 750-754.