I’ve blogged previously about how clinical practice guidelines are bullshit and that about half of them are based on little or  no evidence whatsoever. And now it is clear that most of the doctors who are writing these guidelines are on the payroll of the pharmaceutical industry. And that these guidelines are used for ‘follow the guidelines or you aren’t following the standard of care’ kind of bs.

Now we have more evidence that the guidelines really are just infomercials to promote utilization of prescription medications. An article in JAMA asserts that the entire process of the development of “expert guidelines” is problematic. They go on to state that:

Guidelines often have become marketing tools for device and pharmaceutical manufacturers. While the ACC and AHA receive no industry funding for guideline development, they do receive industry support to disseminate guideline products such as pocket guides. Financial ties between guideline panel members and industry are common. “Experts” on guideline panels are more likely to receive industry funding for research, consulting fees, and speakers’ honoraria.

Other news in JAMA this week is that physicians should be taught to be more conservative in their drug prescribing behavior. Something we have always advocated here at the Drug News and Health Safety Blog. Too often we wip out the prescription pad with the attitude that it “can’t hurt”. Well with 106,000 deaths each year related to prescription medications, I wouldn’t agree that this is the case.

Remember this guy?

Deaths from prescription medications, most commonly pain killers and benzodiazepines and other sedatives, are on the rise, and now more commonly result in death than the abuse of non-prescription drugs, like heroin and cocaine.

Hat tip to CDC mole.

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

In a sign of their undying loyalty to drug and device makers the Republicans have declared their opposition to a plan to add a billion dollars to the stimulus package to study the relative cost and effectiveness of different treatments for chronic conditions, a plan which President Obama is expected to sign tomorrow. I simply had to ROTFL when I read this quote in the NY Times this morning (“US To Compare Effectiveness of Treatments”):

Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.

In other words, drug and device makers wouldn’t be allowed to use expensive treatments that don’t work! OMG!

The pharma and device maker cheerleaders don’t have any rational reason for their retarded statements so they get Rush Limbaugh to go on the air and blabber about how I don’t want the government to tell me what kind of healthcare I got and here is a caller who lived in Canada and blah blah blah blah…

The article used several examples of bogus treatments that have not been shown to be better than conservative treatments, like surgery for neck pain, or claudication (pain in legs from artery disease). In fact most of the examples involved bogus surgeries.

I hate surgeons!

As the article pointed out we now spend 16% of our gross domestic product (GDP) on healthcare, and that amount is expected to increase to 25% by 2025. The article quoted the CEO of Glaxo making a vieled reference to “other countries” who have tried to come up with rational guidelines to inform their clinical care. What he is referring to is the National Institute for Clinical Excellence (NICE) in England, where they actually evaluate what treatments do and do not work. I think the evaluations of treatments done by NICE are the best in the world. Needless to say, pharma doesn’t like it when someone does a rational evidence based assessment and comes to the conclusion that one of their drugs is useless, or no better than a cheaper generic.

Based on these guys logic, since it is a bad idea to find out if a treatment works or not we might as well go back to the treatments of choice of the middle ages, like blood letting.