Professional Societies Should Abstain From Authorship of Guidelines and Disease Definition Statements.

October 2018 1 © 2018 American Heart Association, Inc. Guidelines and other statements from professional societies have become increasingly influential. These documents shape how disease should be prevented and treated and what should come within the remit of medical care. Changes in definition of illness can easily increase overnight by millions the number of people who deserve specialist care. This has been seen repeatedly in conditions as diverse as hypertension, diabetes mellitus, composite cardiovascular risk, depression, rheumatoid arthritis, or gastroesophageal reflux.1 Similarly, changes in prevention or treatment options may escalate overnight the required cost of care by billions of dollars.2 Should the specialists of the respective field be the developers for such influential articles? Many influential professional society documents are written exclusively by insiders. Joining such guideline panels is considered highly prestigious and allocation of writing positions is a unique means to advance an expert’s visibility and career within the specific medical specialty. The number of authors plus collaborators in the masthead of these influential documents sometimes exceeds 100 (eg, 118 for the 2014 European guidelines on myocardial revascularization). Hundreds and thousands of designated guideline coauthors share in the society-wide power game across a large portfolio of guidelines and statements that improve, fine tune, or manipulate disease definition and management. Tens of thousands of society members then cite these articles. This creates a massive, clan-like, group self-citation network. Eight of the 15 most-cited articles across all science published in 2016 are medical guidelines, disease definitions, or disease statistics (Scopus search, May 11, 2018). Cardiovascular medicine and its powerful professional societies (European Society of Cardiology, American Heart Association, American College of Cardiology) have the lion’s share. Cardiovascular experts represent almost half of the most-cited scientists in Clinical Medicine according to Clarivate Analytics (Web of Science). Most (not all) citation superstars get bulk citations by coauthoring guidelines, industry trials, and nonsystematic expert reviews. Stardom is the interwoven product of guidelines and industry links (Table). Industry trials nurture opinion leaders who then solidify their clan power authoring guidelines that serve the industry. Professional society journals also benefit. For example, European Society of Cardiology guidelines are published in the European Heart Journal and of the 20 most-cited articles of this journal in the past decade, 19 are guidelines and 1 is an article on definition of myocardial infarction (Web of Science search, May 11, 2018). The impact factor of the European Heart Journal increased from 2.137 in 1997 to 20.212 in 2016 (the highest among cardiology journals). In the US, similarly, most of the top-cited articles in Circulation are disease statistics, disease definitions, and American Heart Association/American College of Cardiology guidelines. Nine of the 10 articles contributing the most to the 2016 impact factor of European Heart Journal and 8 of the 10 articles contributing the most to Circulation: Cardiovascular Quality and Outcomes