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Healthy Skepticism Library item: 17128

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Grol R
Has guideline development gone astray? Yes
BMJ 2010 Jan 29; 340:
http://www.bmj.com/cgi/content/full/340/jan29_1/c306


Abstract:

It is a long time since clinical guidelines were seen as cookbook medicine and a threat to professional autonomy. Nowadays, evidence based guidelines are considered one of the major efforts to improve patient care. Development of guidelines has progressed enormously, with many organisations (including the National Institute for Health and Clinical Excellence in the UK) using validated methods such as the AGREE instrument.1 Clinical guidelines are valid if they are developed in a rigorous way, independently of vested interests of their developers, and if they support decision making in practice and affect actual care. But are current guidelines meeting these criteria? I have concerns.

For guidelines to have an impact on actual care, they need to be integrated with other quality improvement initiatives, such as performance measurement and quality improvement programmes. This requires intensive collaboration between the organisations responsible for these tasks,2 which is lacking in most countries. Expert guideline . . .

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909