Contents lists available at ScienceDirect Clinical Epidemiology and Global Health journal homepage: www.elsevier.com/locate/cegh Disclosures of conflicts of interest in clinical practice guidelines Red Thaddeus D. Miguel a,∗ , Maria Asuncion A. Silvestre a,b , Ma Lourdes A. Salaveria-Imperial c , Maria Teresa S. Tolosa d , Gina Antonina S. Eubanas e , Leonila F. Dans a,f a Asia-Pacific Center for Evidence-Based Healthcare, Manila, Philippines b Kalusugan Ng Mag-Ina, Inc. (KMI or Health of Mother and Child), Quezon City, Philippines c Dr. Jose Fabella Memorial Hospital, Manila, Philippines d St. Luke's Medical Center College of Medicine – William H. Quasha Memorial, Quezon City, Philippines e St. Luke's College of Medicine, Quezon City, and Daniel Mercado Medical Center, Batangas, Philippines f College of Medicine, University of the Philippines, Manila, Philippines ARTICLE INFO Keywords: Clinical practice guidelines Conflicts of interest GRADE AGREE II Disclosures ABSTRACT Problem considered: Despite promotion for adequate declarations of conflicts of interests (COI), clinical practice guidelines (CPGs) continuously fail to provide suitable statements. It was our aim to investigate the frequency of COI reporting in Philippine CPGs and possible associations of COI disclosure and use of the Grading of Recommendations, Assessment, Development and Evaluation or GRADE methodology. Methods: Eighty-seven CPGs developed in the Philippines before 2017 were appraised for adequate COI dis- closures using Item-23 of the AGREE II instrument. Explanatory variables included indications of use of GRADE, professional organization that led the development of the CPG, and year of CPG completion. Results: Only 12 CPGs (13.8%) had a COI score above the base COI score, with a mean COI score of 5.5 (SD: 1.5). COI disclosure was not statistically different between CPGs that reported or did not report using GRADE (p = 0.2196). Similarly, there was no difference in COI reporting by surgical versus non-surgical organizations (p = 0.5264). The increase in the number of Philippine CPGs was strongly correlated with COI reporting (r = 0.82, p = 0.0001). There was a steady increase of COI reporting through the years, from 5.3% in 1999–2006 to 35.3% in 2016 (p = 0.03427). Conclusion: Despite improving levels of compliance in reporting COIs in recent years, the overall number of disclosures remain low even when GRADE methodology was reportedly implemented. The findings indicate the need for better GRADE training, a clearinghouse for monitoring disclosures, and future studies on the impact of COI disclosures on quality of recommendations. 1. Introduction Declaration of conflicts of interests (COI) must be made to uphold the integrity of evidence published and disseminated. Despite incessant promotion by journals, authors continuously fail to provide suitable statements regarding their conflicts of interest. 1,2 A study by Kessel- heim and colleagues tracked down whistleblower complaints of alleged off label promotion by researchers. The results of the study revealed that out of 404 publications, only 62 (15%) had adequate disclosures. 3 Another study compared payments made by orthopedic device com- panies to consultants and information provided by these consultants on their published disclosures. Only 44 (46%) of these authors’ 95 pub- lished articles had disclosures of a financial relationship with the or- thopedic device company from which they had each received at least $1 million in the year preceding publication. 4 Existing evidence shows a relationship between sources of funding and variances in reported outcomes. 5,6 Non-disclosure of COI leads to severe consequences in health care. Not knowing the competing inter- ests of authors could be detrimental to the uptake of results and con- sequent administration of treatments. Authors should be transparent with their conflicts, real or perceived. Doing so will allow physicians, patients, and other stakeholders to determine how the reported COI may have influenced the outcome of the study. As with academic papers, clinical practice guidelines (CPG) must adhere to the ethical principles of disclosing COIs. Recommendations made by CPGs from evidence that has been acquired, appraised, and synthesized have helped change the way medicine is now practiced. 7 Physicians and other health care professionals are increasingly turning https://doi.org/10.1016/j.cegh.2020.10.009 Received 16 September 2020; Received in revised form 13 October 2020; Accepted 28 October 2020 ∗ Corresponding author. E-mail address: rtdmiguel@gmail.com (R.T.D. Miguel). Clinical Epidemiology and Global Health 9 (2021) 355–359 Available online 05 November 2020 2213-3984/ © 2020 INDIACLEN. Published by Elsevier, a division of RELX India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). T