SIGN guidelines: transparency and objectivity

It has been a good while since I last wrote about SIGN Guidelines. In fact my last communication to SIGN was the following e-mail (of over a year-and-a- half ago):

003 SIGN

I was concerned at that time that SIGN guidelines lacked in necessary governance regarding financial conflicts of interest.

Those that know me understand that I have an interest in ethics. That interest in itself does not make me more “ethical” than any other. I am however passionate about science. If science seeks to be objective we must insist on transparency. This is why I raised a petition for a Sunshine Act with the Scottish Parliament:

The Herald 31 Jan 2014

A year-and-a-half-on, whilst some improvements have been made by SIGN, my view is that these improvements are very far from sufficient. In terms of providing transparency of potential financial conflicts of interest my personal view is that SIGN compares poorly to the level of transparency provided by NICE (England and Wales).

SIGN Guidelines (those that have declarations of interest):
There is no detail in any of the current declarations. So we cannot know how much Dr X, Independent expert Y, or Academic Z might have been paid in the last 3 years. There seems to be little standardisation of what is collected by SIGN. No specific dates of payments are given, and very rarely are there any actual details of payment.

So a year-and-a-half on, as a professional who wishes to be guided by evidence-based science, I remain concerned about the level of public transparency provided by SIGN in terms of declaration of financial conflicts of interest.

If paid: the public should know exactly how much Dr X, Independent expert Y, or Academic Z was reimbursed for working with industry.

In my view such payments should have no “three year window”. Every payment should be there, for all to see, for all time.

Last year, in the UK £41 million was paid by the pharmaceutical industry to the likes of “X, Y and Z.”

My personal view is that SIGN governance still does not provide sufficient transparency to inform us how much X,Y, or Z, might have have received from industry.

What follows is an update since a year-and-a-half ago. It is another “pattern” of a sort:

Apart from my communications to, and and the replies from SIGN, 
all the material in this post has been openly sourced and is in 
the public domain

From the Chair of SIGN, 26 February 2014:004 SIGN

My reply:005 SIGN

The origin of my concern (November 2013):
44 separate SIGN guidelines in operation across Scotland but with no record of declarations of interest.

My original inquiry was borne of  a specific guideline that is still in operation today. It is 6 years beyond the date SIGN scheduled for its review. We will never know if there may have been financial conflicts of interest in those, including the Chair, tasked with drawing up and publishing this still operational SIGN guidance.

44 guidelines without record of COI (20 Nov 2013)

January 2014: Sufficiently concerned about this, my wife and I wrote to the British Medical Journal:SIGN guidelines transparency

This was the response by SIGN:SIGNs reply to Gordon & Gordon

The subject of transparency of financial conflicts of interest for those involved in developing guidelines has featured in science journals across the world:three quarters

In Scotland, I have provided evidence to the Scottish Parliament that NHS Boards have not been following, for more than a decade, Scottish Government Guidance that was first issued to all NHS staff (HDL 62) in December 2003

The Scottish Government Guidance of 2003 made it clear that this was a responsibility of every Chief Executive in NHS Scotland.

Alex Neil, former Cabinet Minister for Health wrote to me to reconfirm that all Chief Executives were expected to follow this Scottish Government Guidance [letter dated 31st October 2013].

010

Last year, in the UK, £41 million was paid by industry to healthcare workers. This aggregate sum does not seem to  include the academics and independent experts who may also “educate” NHS healthcare workers at CPD accredited conferences [CPD is a GMC requirement]. All payments, beyond the aggregate, are thus completely hidden.

The ABPI voluntary reregister (to begin next year) will continue to allow such hiding.

009

How guidelines can fail us.Sept 2014 BMJ Editor

What follows is taken from the minutes of SIGN Council since I first raised concern with SIGN about its governance of this matter [all highlighting is mine]:

SIGN Council Meeting, 4th November 2013:SIGN Nov 2013

SIGN Council Meeting, 5th March 2014:SIGN March 2014

SIGN Council Meeting, 28th May 2014:SIGN May 2014

The following screenshots, all from today, 3rd September 2015, are a brief, ad hoc selection of the current operational SIGN guidelines, that have no surviving record of any potential financial conflicts of interest for any of those involved in developing each individual guideline.

If you want to see more: type into GOOGLE “SIGN Guidelines” and next to this “declarations”:

SIGN 98 - no register of interestBipolar disorder chronic kidney disease GI bleeding Head and Neck cancer obesity Parkinson's disease  Stroke or TIA

3 Replies to “SIGN guidelines: transparency and objectivity”

  1. Peter well done on all your hard work. As you may know, my petition has led to the promise of a SIGN looking at guidelines for hypothyroidism. In light of your investigations and the Sunday Mail investigation, I rather hope they don’t bother. My old doctor is one of those named and is on the SIGN committees and takes payments from pharma.

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