Blog — The Snow Report

Can you trust clinical practice guidelines?

Posted on September 18, 2013 by

Can you trust clinical practice guidelines? Thank you, Gary Schwitzer of  HealthNewsReview.org for an excellent blog post on the BMJ (British Medical Journal) article about conflicts of interest on clinical practice panels. The BMJ article details some of the types of conflicts common on the clinical practice panels that issue treatment guidelines.

As a Minneapolis healthcare PR firm dedicated to promoting the transformation of healthcare to a patient-focused, outcomes-based model, we believe it is vitally important that engaged patients receive evidence-based, unbiased information.

Article offers suggestions on how to protect patient interest

British Medical Journal

For example, in the controversial area of PSA testing, the article notes that The American Urological Association’s best practice update in 2009 and its 2013 practice guidelines reflected potential conflicts of interest in the context of association sponsorship, committee chair conflicts and multiple panel member conflicts. The article contrasts this with the conflict-free status of the U S Preventive Services Task Force in 2012.

Who do you believe?

While the U.S. Preventive Services Task Force found harm from routine PSA testing and no evidence of net benefit, the American Urological Association 2009 guidelines promoted routine PSA testing. In 2013, the Association revised its guidelines to reflect a more conservative approach to PSA testing.

As noted elsewhere, studies have found troubling patterns of conflicts of interest in practice guideline panels, and or lack of full disclosure of those conflicts. Part of the answer is the new Physician Sunshine Act, which we’ve written about previously, that requires the reporting of financial payments to physicians by pharmaceutical and medical device companies.

Avoiding Red Flags

The BMJ authors recommend that professional journals avoid the following red flags:

  • Sponsor(s) is a professional society that receives substantial industry funding;

  • Sponsor is a proprietary company, or is undeclared or hidden

  • Committee chair(s) have any financial conflict*

  • Multiple panel members have any financial conflict*

  • Any suggestion of committee stacking that would pre-ordain a recommendation regarding a controversial topic

  • No or limited involvement of an expert in methodology in the evaluation of evidence

  • No external review

  • No inclusion of non-physician experts/patient representative/community stakeholders

  • *Includes a panelist with either or both a financial relationship with a proprietary healthcare company and/or whose clinical practice/specialty depends on tests or interventions covered by the guideline.

Please take note, healthcare PR professionals, healthcare marketing professionals and journalists. And for full disclosure, this Minneapolis healthcare PR firm works for the parent company of an online source of unbiased medical reference and clinical recommendations. The client had nothing to do with the writing of this blog post, and I take full responsibility for its contents.

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