Patient protection from conflicted medical guidelines

A piece in the BMJ, “Ensuring the integrity of clinical practice guidelines: a tool for protecting patients,” lists:

Red flags that should raise substantial skepticism among guideline readers (and medical journals)

  • 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

*Includes a panelist with either or both a financial relationship with a proprietary healthcare company and/or whose clinical practice/specialty depends on tests or interventions covered by the guideline

Journalist Jeanne Lenzer was one of the authors, and this work follows her earlier BMJ piece, “Why we can’t trust clinical guidelines.” In it, she concluded by writing:

(numerous) guidelines continue to be followed despite concerns about bias, because as one lecturer told a meeting on geriatric care in the Virgin Islands earlier this year, “We like to stick within the standard of care, because when the shit hits the fan we all want to be able to say we were just doing what everyone else is doing—even if what everyone else is doing isn’t very good.”

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