Wednesday, March 30, 2011

Are guidelines tainted?

One of the truisms of healthcare is that we should adhere to guidelines in so far as possible, to reduce variation, to improve outcomes and to minimize waste. Guidelines are developed by eminent professionals in a field; it is assumed that they are guided only by the evidence. However, many of these guidelines are sponsored by pharma companies.
A study just published in the Archives of Internal Medicine examined conflicts of interest amongst panel members charged with developing almost 20 cardiology guidelines. They find that 56% of panel members have a declared conflict of interest, e.g. owning stock in a company whose product is recommended, and 81% of panel leaders have a COI. That is not to say that these were unduly influenced by these conflicts, but some wonder whether like Caesars' wife, all should be above suspicion.
One suggestion is to prohibit all guideline developers to have a COI; my own view on this is that it may just exclude those who have the most to offer.

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