How to Determine If a Clinical Practice Guideline is Trustworthy

An interesting article titled “How to Decide Whether a Clinical Practice Guideline Is Trustworthy,” written by David F. Ransohoff, MD Michael Pignone, MD, MPH, and Harold C. Sox, MD appears in JAMA, January 9, 2013,Vol 309, No. 2, pp. 139 -140. The article mentions how many controversies have arose recently over cancer screening guidelines. The article mentions how in 2008 Congress gave the Institute of Medicine (IOM) of the National Academies with developing standards for objective, scientifically valid, and consistent approaches to developing practice guidelines.

Well as I mentioned in this blog post Tips to Prevent Medical Errors – AHRQ Congress actually gave the Agency for Health Care Policy and Research (AHCPR) in 1989 evidence-based, clinical-practice guidelines. However, the medical device industry and several doctors organizations opposed this as it was threatening to limit their profits and found a sympathetic ear with the Republican Controlled House Majority who crippled the budget of AHCPR and turned it into AHRQ.

The authors state

“The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. Therefore, the first requirement for earning trust is a rigorous process for assembling, evaluating, and summarizing the evidence. This requirement is satisfied by performing a systematic review and assessing the quality and strength of the body of evidence. This process requires clinical epidemiological skills and a substantial investment of resources.”

The authors state that IOM provided a comprehensive set of standards and to be trustworthy a clinical practice guideline should comply with all 8 of the guidelines (which are mentioned in the article). The authors state they randomly reviewed 114 IOM guidelines and none of them meet the definition of being trustworthy. Hence, it is not clear what the appropriate criteria should be. The authors conclude by saying

“Guidelines, especially those that try to set limits, will always raise controversy. Clinicians, patients,and policy makers should insist upon a constructive dialog about the evidence and its translation into recommendations. An explicit, transparent process for evaluating adherence to the IOM committee’s standards should elevate this conversation to a higher plane.”

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