Common Sense of Proportion Missing
Without any doubt it is correct that the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF) asks authors of medical guidelines to disclose any potential conflicts of interest; however, it seems that common sense of proportion is missing in Germany as each potential conflict of interest has to be declared regardless of the corresponding financial value. Here are some examples for this in my opinion unreasonable request for complete political correctness:
- Company A contributes financially to the purchase of an ultrasound scanner which can be used by all colleagues working in the department
- At a congress, company B invites attendees to dinner
- Stock of company C is part of the investment portfolio of a medical pension scheme
- Company D—Lunch symposium—reimbursement of expenses, no fees
- Co-investigator in a multicenter study of company E, placebo arm, EUR 100 per patient.
Regarding this issue, our colleagues in the United States are much more down to earth: for most journals, they have introduced a financial threshold to assist in the evaluation of potential significant conflicts of interest. Currently, this is set at USD 10 000 per annum (1):
“A relationship is considered to be “significant” if (a) the person receives 10 000 US-Dollar or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns 10 000 US-Dollar or more of the fair market value of the entity.”
Of course, there is room for discussion about where this threshold should be in Germany. Nevertheless, a clear statement on this matter by the professional societies, including the AWMF, which reinstates the required common sense of proportion and thus puts a stop to this excessive and unhelpful regulation, is long overdue (2). No colleague invited to a lunch or dinner once or twice has a potential or significant conflict of interest when it comes to producing a scientific guideline.
Prof. Dr. med. Nikolaus A. Haas
Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin
Klinikum der Universität München (LMU)
|1.||Giglia TM, Massicotte MP, Tweddell JS, et al.: Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientific statement from the American Heart Association. Circulation 2013; 128: 2622–703 CrossRef MEDLINE|
|2.||Schott G, Lieb K, König J, et al.: Declaration and handling of conflicts of interest in guidelines—a study of S1 guidelines from German specialist societies from 2010–2013. Dtsch Arztebl Int 2015; 112: 445–51 VOLLTEXT|