Healthy Skepticism Library item: 19454

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

Nissen SE
Can We Trust Cardiovascular Practice Guidelines?
Arch Intern Med 2011 Mar 28; 171:(6):584
http://archinte.ama-assn.org/cgi/content/extract/171/6/584

Abstract:

Clinical practice guidelines play an enormously important role in society and the practice of medicine. Individual physicians use CPGs to determine which diagnostic tests and therapeutic strategies are most appropriate for their patients. Government and third-party payers use CPGs to determine which procedures and drugs should receive reimbursement. Hospitals and clinics use these CPGs to decide when innovative, but expensive, therapies are sufficiently mature to warrant a major investment. Increasingly, government, the public and the media use CPGs as a benchmark to gauge the quality of medical practice for both hospitals and individual physicians.1-3 Accordingly, protecting the integrity and reliability of CPGs is essential to society and fundamental to the practice of evidence-based medicine.4

INDEPENDENCE AND RELIABILITY OF CPGs IN CARDIOVASCULAR MEDICINE

In this issue of the Archives, Mendelson et al raise disturbing questions about the independence and reliability of CPGs in cardiovascular medicine. They report the presence of financial relationships with commercial entities . . .

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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