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 … Read more

Looking at Evidence Supporting Dental Procedures from Cochrane Systematic Reviews

An interesting article titled “Is the Evidence Supporting Dental Procedures Strong? A Survey of Cochrane Systematic Reviews in Oral Health” by Clovis Mariano Faggion Jr. appears in J Evid Base Dent Pract, vol. 12, pp. 131-134, 2012. The article sets out to explore Cochrane systematic reviews and whether or not they provide useful information for use in dentistry. The author set out to look at the quality of evidence for Cochrane systematic reviews published in dentistry. The evidence was considered inadequate when authors described weak or insufficient evidence or when no studies were selected for the review. A total of 120 systematic reviews were looked at for 20 topics. The author did have some creative interpretation to assess the reviews. He states: “The full text of articles was, however, scrutinized to assess the risk of bias of included primary studies; methodological … Read more

Systematic Review of Prophylactic Extraction of Third Molars: From Brazil

Many reviews have been conducted in recent years to determine if healthy third molars (known as wisdom teeth) should be prophylacticly extracted as in removed before causing problems. A new study by Moacir Guilherme da Costa and four other researchers titled “Is there justification for prophylactic extraction of third molars? A systematic review,” appears in Braz Oral Res., (São Paulo) 2013 Mar-Apr;27(2):183-8. The article discusses how in the United States roughly 10 million wisdom teeth are extracted from around 5 million individuals each year. The article discuss how several reasons are usually given for extracting wisdom teeth pericoronitis periodontal defects in the distal region of the second molar caries in the third or second molars different types of odontogenic cysts and tumors crowding of the lower incisors indications for orthodontic, prosthetic or restorative purposes The authors state how the majority … Read more

Unnecessary Medical Care and Over Used Tests: The Choosing Wisely Campaign

The Choosing Wisely Campaign is an initiative which I believe I first heard about in late 2010 launched by the ACR (American College of Radiation as the Imaging Wisely Campaign) The Imagely Wisely Campaign was designed to have people aware of the fact that certain medical imaging tests such as CT exams were sometimes over used and did not always have to be used in some instances. It seems that the Choosing Wisely Campaign was launched by the ABIM Foundation which is an organization designed to advance medical professionalism to improve patient care. In April 2012 the Choosing Wisely Campaign released some lists of tests and procedures commonly done in 9 medical professions that should be questioned.  In February 2013 an additional 18 lists of tests or procedures were released. The press release is located at On the website … Read more

Health Care Should Not Be Framed in the Personal Responsibility Narrative

I read an interesting article by Micah L. Berman titled “From Health Care Reform to Public Health Reform” appearing in the Journal of Law, Medicine & Ethics (Fall 2011, pages 328-338). In the article Micah L. Berman discusses how the Affordable Care Act contains an “individualist/biomedical paradigm” which includes a number of provisions and programs which focus on public health but are in fact misaligned and at odds with public health research. He does this by first (A) arguing that in America there is a large cultural emphasis on personal responsibility which is shaped by powerful political, social, and psychological forces and second (B) that influential industries profit at the expense of public health. A) Micah states: “This paradigm focuses on what can be done by or to individual patients, and it leads to policies that seek to either (a) … Read more