Monday, September 23, 2013

Reforming Clinical Guidelines

If you've been following my various linkaways on this blog over the last couple months, you've seen me highlight an investigative report by Jeanne Lenzer regarding some of the controversial recent clinical guidelines.  Beyond that, however, is Part 2 of this project – where a team headlined by Jerome Hoffman, Curt Furburg, and John Ioannidis came up with a set of evaluation criteria for worrisome conflicts-of-interest in clinical guidelines.

These evaluation criteria, a set of "red flags", chosen over months of debate:
  • 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
As you can see, the list includes several types of sponsorship COI, as well as other cautions meant to ensure objectivity and patient-centric recommendations.  Whether this set of "red flags" becomes a useful tool for future guideline evaluation yet remains to be seen.  As should come as a surprise to no one, the new ACEP/AAN tPA clinical policy – evaluated independently of the guidelines Working Group – garners an unimpressive six "red flags" and a "caution".

William Mallon, David Newman, Kevin Klauer, myself, and many others contributed to this project.

"Ensuring the integrity of clinical practice guidelines: a tool for protecting patients"
http://www.bmj.com/content/347/bmj.f5535

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