The American College of Cardiology recently retracted one of its magic five "Choosing Wisely" recommendations.In 2012 ACC had advised that in the setting of an acute coronary event one should only revascularize the "culprit artery".This is the artery thought to be responsible for the event and if other obstructions are detected the ACC said that there was evidence that the fix everything approach might be harmful.This advice was based on non randomized trials. Here is ACC's official statement.
Now apparently two randomized trials suggest one should fix (place a stent in ) the other obstructions. Here is quote from ACC:
“over the last two years, new science has emerged showing potential
improvements for some patients in their overall outcomes as a result of
Larry Husten,prolific medical journalist whose Forbes article on this subject is linked above, really nailed it , quote:
" It seems to me that the medical organizations that produce guidelines
should freely admit this lack of evidence for most recommendations.
Then, instead of getting their panties all in a bunch trying to defend
the indefensible– as we saw recently with the salt guideline– they could advocate for better evidence...So if they want to make the case for more data they will have to first
acknowledge their ignorance.
Acknowledging ignorance seems the last thing likely to emerge from the guidelines generating organizations.
In 1728, the three verdict system arose in Scottish Criminal cases.The accused could be found guilty,not guilty or not proven. So guilty, not guilty or admitting their ignorance and admitting we just can't say.
Being a guideline author seems to confer
immunity for having to say you are sorry. The individual physician
strives to do what is the right thing for his patient and hopes that
what he does is right, the quality rule makers are able to summon up sufficient hubris to presume to know what
is good for everyone. Of course they frequently do not. Remember the beta blocker fiasco.