Monday, October 24, 2005

Yet another problem with guidelines

Guidelines are great; guidelines are terrible. Internists are of two minds-at least two- regarding guidelines. We resist the harness of being told what to do (although the authors of the guides always include a declaimer that they are not telling what to do and clinically judgment and patient preferences must be given weight) but welcome the relief of finding an easy answer to a given clinical issue. We resist even more vigorously the threat and the reality of being graded-and with P4P being paid- according to this or that guideline. Should I get a pap test this year, doctor? Well the ACOG or the ACS says..... Kevin MD calls our blogish attention to a recent article casting a cloud over the process by which at least some guidelines are prepared. The issue here is the putative influence of the drug manufacturers on the process and the ties the guideline writers have to Big Parma. HCRENEWAl and others have done a great job in directing our attention to various ways in which seemingly reputable medical journals are and have been greatly influenced in ways that may put the volume of sales of certain medications about the priority of scientific inquiry and good faith reporting of data. (If we believe the comments of some journal editors,they were as duped as we were). Well, should anyone be surprised if the same entities have considerable influence on the particulars of various panel's recommendations regarding the indications for various drug and procedures and if the default position is to use more medication(s) for more indications? If we accept RCTs as the top of the line evidence and we have good reason to be at least skeptical about the influence of Big Pharma on those trials it follows that guidelines based to a large degree on those studies will be smeared with the same mud.

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