Clinical Guidelines: let’s be transparent

Dr Peter J Gordon and Dr Sian F. Gordon

Jeanne Lenzer’s feature article, “Why we can’t trust clinical guidelines[1]” has attracted a considerable number of responses, many of which highlight individual clinical guidelines where particular issues of conflicts of interest have arisen.

One course of action would be that any clinical guideline should have all potential conflicts of interest recorded and as easily available to the reader as the guideline is. This would allow the reader to make his/her own assessment of the advice given. Indeed the Scottish Intercollegiate Guidelines Network (SIGN) states that “SIGN is committed to open declaration of competing interests in all its activities[2].” However, the Programme Lead for the SIGN stated on the 20th November 2013 “It is my expectation that none of the guidelines prior to and including SIGN 114 (excluding SIGN 88, SIGN 93 and SIGN 101, which have been updated in the last three years) will have a record of the declarations of interest of the group members. This totals forty-four guidelines, of which six will have updates published in 2014 (with current declarations of interest)[3].”

We would urge SIGN and other guideline authors finding themselves in the same position to make it clear that current standards on transparency have not been met for a significant number of clinical guidelines still in use.

[1] Lenzer, J Evidence Based Medicine: Why we can’t trust clinical guidelines. Published 14 Jun 2013 BMJ 2013; 346 doi:

[2] SIGN Guidelines.  Policy on Declaration of interests. File name: 20111219. Dated 23 Jul 2013

[3] Programme Lead for SIGN Guidelines. E-mail communication to Dr Peter J. Gordon. 20 Nov 2013.

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