Healthy Skepticism Library item: 3811

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Publication type: Journal Article

Gazarian M, Kaye KI.
The road to consensus: considerations for the safe use and prescribing of COX-2-specific inhibitors.
Med J Aust 2002 Nov 18; 177:(10):572-3

Abstract:

The authors, from NSW Therapeutic Assessment Group, in discussing the “what” of guideline development question the assertion by Edmonds et al. that formulation of precise indications for the use of non-steroidal anti-inflammatory drugs versus COX-2 specific inhibitors would generate interminable controversy. The NSW TAG successfully developed evidence-based recommendations on indications for the use of celecoxib without generating such controversy. The different experiences may partly be related to a difference in the initial level of consensus on the importance of the topic. The “how” of the process followed by Edmonds et al is not described in sufficient detail to enable systematic evaluation of its validity. Getting the right “who” is a prerequisite for getting the “how” right. Authors with significant conflicts of interest should be excluded from participating in guideline development. The rationale for arbitrary selection of members and inclusion of members from the pharmaceutical industry is not explicitly stated. These issues may have contributed to the difficulties the group experienced.

Keywords:
*letter to the editor/Australia/ Consensus Cyclooxygenase 2 Cyclooxygenase 2 Inhibitors Cyclooxygenase Inhibitors/adverse effects Cyclooxygenase Inhibitors/therapeutic use* Drug Utilization Review Evidence-Based Medicine Humans Isoenzymes/antagonists & inhibitors* Membrane Proteins Practice Guidelines/standards* Prescriptions, Drug/standards* Prostaglandin-Endoperoxide Synthases Safety