Resolving the Conflict of Interest in Corporate Involvement with the Society of Critical Care Medicine and the Surviving Sepsis Campaign

A conflict of interest is a situation in which people have competing professional or personal interests. Thus, a conflict of interest exists only because the competing interests exist, whether or not there are improper actions derived from those interests.

The association of the Surviving Sepsis Campaign (the Campaign), the Society of Critical Care Medicine (SCCM, the Society) and corporate sponsorship by Eli Lilly (Lilly) was documented in a recent New England Journal of Medicine article (Eichacker PQ et al. Surviving sepsis — Practice guidelines, marketing campaigns, and Eli Lilly. N Engl J Med 2006 Oct 19; 355:1640-2). This article demonstrated a conflict of interest within the Campaign that may have biased the sepsis guidelines. The authors argued that there should be a "firewall" between industry and guideline development.

Opinions from executives and members of the SCCM were published in the Society's journal Critical Care Medicine and elsewhere. They reasoned that although the guidelines were partly funded by Lilly, there was no corporate influence on the outcome. They cite the standard objective procedures used to formulate the guidelines, the integrity or the people and the process, the laudable goals of the campaign, and that the guidelines are being newly redone without corporate sponsorship.

In my opinion, the Society's reasoning is flawed. First, conflicts of interest may bias outcomes despite using the best procedures. Second, in configuring a new committee to redo the guidelines, the Society had used many of the same people on the original committee, as though the conflict of interest no longer exists. In fact, the SCCM has never disclosed the personal financial arrangements between individual members of the Campaign committee and Lilly. Thus, in my view, the major interest of the Society and Campaign are to spin an illusion that the original opinion of the Campaign was objective without testing that opinion by the scrutiny of new and independent sepsis and guideline experts.

There is no question that members of the Campaign had conflicts of interest as pointed out in the uncontested facts in the New England Journal article cited above. There is also no question that the published rhetoric from the society has not resolved whether the conflicts of interest affected the Campaign's recommendations.