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This week’s JAMA has an article that evaluates guidelines written for the appropriate treatment of a variety of cardiac conditions. These are guidelines written by experts in the field about appropriate treatments for a variety of conditions, from heart attacks to atrial fibrillation. The guidelines were ranked according to level of evidence, with guidelines ranked as A being based on multiple clinical trials, B based on a single study, and C based on expert opinion, “standard of care”, or case studies. The study showed that in 54% of cases, the guidelines were based on evidence ranked as C, in other words the personal opinions of whoever was writing the guidelines. The other finding was that the number of guidelines were increasing all the time, in spite of the fact that the evidence to support these opinions wasn’t.
In other words, about half the time someone is writing something and everyone else is supposed to go along. This is actually how medical education works; you see the professor prescribe in a certain way, and you do the same. Given the fact that the pharmaceutical industry has moved in and gotten control of leaders in their fields, through payments for consulting and lecturing, whom they derisively refer to as “KOLs” (Key Opinion Leaders), and whom pay consulting groups to “manage their KOLs”, you shouldn’t have much confidence in these guidelines, as I wrote about recently in “How Much You Gonna Pay Me for Those Guidelines.”
Dr Curt Furberg testifies before Congress regarding expert consensus guidelines
Hey! I think I came up with a better use for those guidelines!
A better use for expert consensus guidelines
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That statistic is frightful. Even more frightful knowing that the “expert opinion” was probably payed off for that opinion or a case study (it worked for me, it HAS to work for you!)
Doug,
This is pretty frightening. Makes me wonder how many docs out there are prescribing just because someone told them to….
My dad was diagnosed with alzheimer’s a while back, and doing much better now thanks to some chinese club moss, omega 3′s, folic acid, and grapeseed extract.
I read a book about alzheimer’s by an m.d…..this guy put stuff in there about depression over and over….kept mentioning giving all kinds of mind-altering drugs to older people….always for ‘at least six months’…..
This stuff of course shuts down the heart of these older people….I wondered the whole time I read his book….Why he was saying it….Was he being paid by big pharma….Maybe it was the ‘way he was taught’…..Interesting post…..Thank you.
Duane
Would that the average physician actually follow ANY guidelines when treating Adult ADHD!
Instead, too often they simply wing it — “here, try this” — and usually starting at too high a dosage.
I had to write a book, for petesakes, in order to educate consumers as to the recommended protocols for developing an effective medication regimen for ADHD. That way, readers can explain it to their treating physicians. It’s my hope that more diligent, careful prescribing will result in fewer of the adverse side effects that have scared too many people away from these medications.
It’s hard to believe the recklessness until you hear reports on a daily basis, as I do, from all over the country.
I personally loved your cartoon!!! I believe that you nailed this dead on!! When 6 of 10 commercials during prime time TV are pharma. They must have a lot of profit in experiment money left lying around to hand out to doctors, instead of spending it on real testing. Hey, I gotta Doc over here that’s in for a few thousand, we can negotiate a percentage of sales for him right? The Dumbing of America!