Wednesday, June 19, 2013

BMJ, Clinical Guidelines & tPA

A little hullabaloo today regarding a new report in the BMJ regarding problems with the creation of clinical practice guidelines, including a substantial portion of the article devoted to the conflicts of interest swirling about the use of tPA in acute ischemic stroke.

There have already been personal attacks – even from ACEP's official twitter account – against the author.  These seem to be motivated by the author's coverage of the new ACEP/AAN clinical practice guidelines for tPA – and miss the overall point that patients are best protected and served by guidelines that are formulated in the absence of conflict-of-interest.  tPA for acute stroke, erythropoetin endorsement by the National Kidney Foundation, the errant one-man crusade for steroids in spinal cord trauma, and cholesterol treatment guidelines are all discussed in the context of cautionary tales regarding the influence of conflict-of-interest.

Whichever side of the expand/limit tPA in acute stroke debate you fall upon, the issues of sponsorship bias, one-sided panelists on a still-controversial practice, and lack of open peer review for the ACEP/AAN guidelines ought to be unacceptable.  Patients and practicing clinicians benefit from healthy debate and recognition of the limitations of the science, which seems clearly to have been lacking in the creation of these guidelines.

"Why we can’t trust clinical guidelines"


  1. holy crap! who is the doc tweeting as ACEP

    1. No clue – but he/she has been getting a little fast/loose with the official social media voice of >32,000 Emergency Physicians. Not exactly the advocacy for Emergency Physicians and their patients for which I pay dues.

    2. You're just jealous because you aren't tweeting about chainsaw wielding women.

      But I agree, it does appear to be more social and less official.

    3. Holy crap indeed. Raises the issue of what to make of the pseudo-annon social media user presenting themselves either as a groovy handle without an identity behind it or as a social media voice of a large organisation. I wonder whether an ACEP press release would have been that casually tossed off.

  2. Looks like a social media stunt to me.


Comments on posts > 10 days old will be moderated; blame spammers.