Monday, January 21, 2013

What Are "Trustworthy" Clinical Guidelines?

This short article from JAMA and corresponding study from Archives is concerned with advising practicing clinicians on how to identify which clinical guidelines are "trustworthy".  This is a problem – because most aren't.  

The JAMA article paraphrases the eight critical elements in the 2008 Institute of Medicine report required to generate a "trustworthy" article, such as systematic methodology, appropriate stakeholders, etc.  Most prominently, however, several deal specifically with transparency, including this paraphrased bullet point:
  • Conflicts of interest:  Potential guideline development group members should declare conflicts. None, or at most a small minority, should have conflicts, including services from which a clinician derives a substantial proportion of income. The chair and co-chair should not have conflicts. Eliminate financial ties that create conflicts.
The Archives article cited by the JAMA article reviews over 100 published guidelines for compliance with the IOM.  The worst performance, by far, was compliance with conflicts of interest, and notes that 71% of committee chairpersons and 90.5% of committee co-chairpersons declared COI – when declarations were explicitly stated at all.  Overall, less than half of clinical guidelines met more than half of the IOM recommendations for "trustworthiness".

Sadly, another dismal addition to the all-too-frequent narrative describing the rotten foundation of modern medical practice.

"How to Decide Whether a Clinical Practice Guideline Is Trustworthy"
www.ncbi.nlm.nih.gov/pubmed/23299601

"Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards"
www.ncbi.nlm.nih.gov/pubmed/23089902

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