Clinical guidelines have the power to make or break a medication. If a committee recommends against a particular drug, Medicare and Medicaid, and then, likely private insurers, will decline to pay for it. Approvals that do go through can mean millions of dollars in sales, if not more.

So, the guideline committees that make those decisions — and the people who sit on those boards — play an important role for both the companies and the clinicians who want to choose treatments based on science, not money.

That’s why the nonprofit National Comprehensive Cancer Network (NCCN) takes great care to keep those who have financial conflicts off its 56 guidelines panels, noted NCCN CEO Robert W. Carlson, MD, in an interview with Cancer Therapy Advisor.

“Transparency and high-quality development, it’s what we live and breathe,” said Dr Carlson. “We have really rigorous processes in place to assure transparency and rigor and minimizing conflicts of interest. That’s why our guidelines — people trust them.”

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But with companies spending millions each year to change medical minds, and human nature being what it is, conflict-of-interest (COI) specialists say it’s tough to build a conflict-free system as long as anyone’s taking any money at all.

The field of oncology is rife with conflicts, says Vinay Prasad, MD, a hematologist-oncologist and associate professor of medicine at Oregon Health and Science University in Portland. “Compared to other fields, I believe it’s probably one of the worst offenders,” he said, because well over half the drugs under development today are in oncology.

The NCCN’s guidelines look attractive, he said, and seem to be preferred by most clinicians, so he said he expects that NCCN’s committee members would be under significant pressure to accept industry handouts.