February 5, 2014

Most Guidelines Done by People with Conflicts

When I wrote this blog, I felt that this was important and that Dr. Kendrick was correct, but I did not realize that I would see something so quickly from a United States authority. The Mayo Clinic in Rochester, Minnesota published a study in the January issue of Mayo Clinic Proceedings showing that most clinical practice guidelines are based on lower-quality medical evidence and a failure to disclose authors' conflicts of interest.

Then I had to realize that in early 2013 the American Association of Clinical Endocrinologists led by the nefarious Dr. Garber was attempting to have universal acceptance of the diabetes algorithms without disclosure of the authors' conflicts of interest. Fortunately, for patients, a couple of articles made it necessary for them to publish a consensus statement, which also listed the conflicts of interest of which Dr. Garber had plenty.

This is important enough to quote, ““Guidelines are meant to create a succinct roadmap for the diagnosis and treatment of medical conditions by analyzing and summarizing the increasingly abundant medical research,” write Joseph Feuerstein, MD, and colleagues from Beth Israel Deaconess Medical Center. “Guidelines are used as a means to establish a standard of care … However, a guideline’s validity is rooted in its development process.””

Most of the current practice guidelines in publication do not satisfy criteria that represent trustworthiness as defined by the Institute of Medicine. This definitely means that more attention needs to be paid to potential conflicts of interest among guideline authors and guideline development panels.

How much longer will the medical and other groups let the literature continue to grow that documents the existence of potential conflicts of interest reported for authors or members of guideline development panels? I may be wrong, but it seems that they are staying quiet to earn their place on one of these panels or to keep the side income flowing that they are currently receiving.

As a result, the influence of external activities such as consulting or speaking fees, research grant funding and stock ownership has the potential to create significant bias and uncertainty for issued recommendations.” Who pays the price for these greedy doctors and panel members. If you don't think that we as patients will suffer for the guidelines that overreach and promote more medications that have not been clinically proven to be beneficial, then go ahead and take the higher dosage and the extra medication the guidelines insist that we need.

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