August 19, 2013
Guidelines and Those That Develop Them
When I read this by Dr Malcolm McKendrick, I had to think how like some other guideline committees I have written about lately. Dr. McKendrick writes about the group that wrote the cholesterol guidelines and how they attempted to hide the conflicts of interest that those on the guideline committee had. For that digging and forcing the issue, I hope that I am able to properly thank Dr. McKendrick someday.
This paragraph from Dr. McKendrick's blog really makes the point. “In 2004 this committee decided that cholesterol levels should be lowered far more aggressively than in the past. Based on, as far as I could see, very flimsy evidence. Could it be that that committee was, in some way, biased in favour of cholesterol lowering companies? A number of people, including me, demanded to see if any of the eight invited members of this hugely important committee had financial conflicts.”
Yes, they certainly did have financial conflicts and this has to mean that there needs to be more concern about statins our doctors insist that we consume.
This type of digging was necessary for the American Association of Clinical Endocrinologists diabetes algorithms issued on or before April 24, 2013. At first they did not give out any information about the algorithm, conflicts of interest, and missed many points. After a Medscape article and a New York Times article, they still took over a month to issue a consensus statement for the algorithms. Many points were still omitted because they won't accept them as being what happens in the real world. Yet many of us with type 2 diabetes know better and think that the members of the committee are out of touch with what happens outside their towers.
Members of our support group have been thinking that we are the fortunate ones to have doctors that do not completely align themselves with the AACE. We are in agreement that people with conflicts of interest have no business being on committees that develop algorithms or guidelines because we know the bias they bring to the discussions. Whether it is true or just supposition on our part, we feel that some of the conflicts result in extra fees for many of the committee members.
I personally feel that if they had issued a consensus statement with the algorithms, there may have been less criticism, but the criticism they received was well placed and pointed out the shortcomings of the algorithms. It showed us how incomplete the algorithms are in opposition to Dr. Garber's “comprehensive” statement.