The chairman of cardiovascular medicine at the Cleveland Clinic, who is also the past president of the American College of Cardiology, is not impressed by recent assurances that medical experts who write influential practice guidelines will better disclose financial conflicts of interest they have with affected companies, including drug manufacturers and makers of medical devices.

Dr. Steven E. Nissen would strongly prefer that such conflicts simply be banned and that every participant labeled an expert who evaluates relevant science and proffers advice via guidelines to other physicians concerning best practices, preferred medications, medical malpractice and other matters must be clear of suspect associations.

Dr. Nissen's concerns are well-founded, as his views relate to a recent study in the Archives of Internal Medicine concluding that 56 percent of approximately 500 people who wrote guidelines for the American Heart Association and the American College of Cardiology over a recent five-year period had such conflicts of interest. Those conflicts include receiving gifts, taking speaking and consulting engagements and having ownership interests in affected companies.

"The conflicts are quite prevalent, but they're by no means ubiquitous," says Dr. James N. Kirkpatrick, the study's lead author. Notwithstanding Kirkpatrick's view, though, there is widespread concern expressed by many doctors, who note that the likelihood of a conflict increases progressively the higher up the guideline chain a person rises. Study findings indicate that conflicts exist for more than 80 percent of guideline group leaders.

Both of the cited associations say that they now exert tighter controls over potential conflicts. Panel group leaders, for example, must prove that they are conflict-free.

Related Resource: www.nytimes.com "Study Finds Conflicts Among Panels' Doctors" March 28, 2011