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BMJ: US Editors Choice: Getting clinical guidelines right

Firestormm

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Especially interesting, perhaps, given the current climate:
US Editor’s Choice

Getting clinical guidelines right

Edward Davies, US news and features editor
edavies@bmj.com

The importance of transparency with regards to author and industry ties when publishing research is paramount. The degree of disclosure and what exactly constitutes a competing interest will vary by author and journal to a certain extent, but its impact on independence, either perceived or real, is universally acknowledged.

Also acknowledged but far less widely discussed are the interests of those sitting on clinical guideline panels and the lack of consensus on what is acceptable is a problem. Although many guideline panels will base their decisions on the best available evidence, panels are the filter through which the small academic community can disseminate evidence based medicine to the much larger, worldwide physician audience. If that filter is conflicted it can have a major impact on patient care.

Different organisations, regulators and countries take different views on how important this is, but this week the BMJ publishes a proposal from a group of authors that lays out a manifesto for how everyone should approach the subject. It is likely to be imperfect and is intended to provide a starting point for debate rather than a fait accompli, but it has rallied the input of a vast working group including experts in the field from across the United States and beyond and so merits some serious consideration (Ensuring the integrity of clinical practice guidelines: a tool for protecting patients: doi:10.1136/bmj.f5535).

The proposal they give is undoubtedly idealistic in basis and some readers might find it simplistic, but it is also a practical and workable toolkit for physicians looking at guidelines and the hope is that, at the very least, some may be able to better gauge the reliability of the unofficial rules they work to.

Taking this proposal forward and turning the hopes of such a group from an idea to a workable reality is a step that may or may not prove too far, but the reasons for doing it are neatly and inarguably put in the opening sentence of the article: "Clinical practice guidelines should support doctors by identifying and disseminating the most scientifically sound healthcare practices. When performed rigorously, this endeavor improves patient care and elevates the profession toward its scientific ideal."
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S

Sasha

Fine, thank you
Messages
17,863
Location
UK
Wow - look at the red flags identified in that paper that are present in the IOM's GWI panel (my bold), and those are only the ones that I know of:

Box 1: Red flags that should raise substantial skepticism among guideline readers (and medical journals)

  • Sponsor(s) is a professional society that receives substantial industry funding;
  • Sponsor is a proprietary company, or is undeclared or hidden
  • Committee chair(s) have any financial conflict*
  • Multiple panel members have any financial conflict*
  • Any suggestion of committee stacking that would pre-ordain a recommendation regarding a controversial topic
  • No or limited involvement of an expert in methodology in the evaluation of evidence
  • No external review
  • No inclusion of non-physician experts/patient representative/community stakeholders
Nielk, medfeb - interesting, and the IOM is cited in that paper as being big on good process for guidelines (!).
 
Firestormm

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
I guess one of my concerns with this will be that GET and CBT are 'scientifically sound' according to their proponents who are - unfortunately - listened to; and until something better comes along with the 'same rigour' behind it - we could be stuck in the US right where we are in the UK with 'management strategies' for ME. But, I think it also gives accord to the need for consultation before guidelines are published - though I haven't read the paper it alludes to - and this would include (I sincerely hope) disease experts, healthcare experts, patients and patient representatives.

Really crappy night. So I'm not doing anything more today... except trying to :sleep:
 
Desdinova

Desdinova

Senior Member
Messages
276
Location
USA
Taking this proposal forward and turning the hopes of such a group from an idea to a workable reality is a step that may or may not prove too far, but the reasons for doing it are neatly and inarguably put in the opening sentence of the article: "Clinical practice guidelines should support doctors by identifying and disseminating the most scientifically sound healthcare practices. When performed rigorously, this endeavor improves patient care and elevates the profession toward its scientific ideal."
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So what Group(s) or Organization(s) does Weasle & Whitewash and those belonging to their school of thought belong to? Because I'll bet a dollar to a donut that they'll try to insert themselves Professionaly into the development process of said proposed group and guidelines it uses.
 
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