Clinical practice guidelines are meant to help health care providers weigh the pros and cons of the myriad medical options available. But with more than 2,300 recommendations issued by nearly 300 professional organizations and societies, physicians often don’t know which advice to follow. That’s why the US Institute of Medicine (IOM) is calling for a new approach to developing medical guidances.

In two reports published yesterday, the IOM’s Committee on Standards for Developing Trustworthy Clinical Practice Guidelines and the Committee on Standards for Systematic Review of Comparative Effectiveness Research set out nearly 30 recommendations to steer the guideline-making process. “These standards are necessary given that there is little documentation to the judge the quality and reliability of many of the existing clinical practice guidelines,” Sheldon Greenfield, a health policy researcher at the University of California–Irvine who chaired one of the committees, said in a statement.

The IOM reports call for the formation of unbiased multidisciplinary groups consisting of clinicians and patient advocates to create evidence-based guidelines. These guidelines are developed based on the analysis of exhaustive peer-reviewed evaluations of existing therapeutic and surgical interventions carried out by separate review teams. According to the committee, these measures should help overcome the problems that arise when different medical groups have reviewed the same clinical studies and reached different conclusions.

For example, in 2008 the American Cancer Society and two other organizations recommended that doctors use virtual colonoscopies (also known as computed tomography colonography) and DNA-based stool testing for routine colon cancer screening. Yet later that year, the US Centers for Disease Control and Prevention said that there was insufficient evidence to merit the adoption of these screening methods.

The conflicting messages “raise practical questions, not only about what doctors and patients should do in the face of disagreement, but also about the larger process by which guidelines are made and how ‘trustworthy’ they may be,” gastroenterologists Thomas Imperiale of Indiana University School of Medicine in Indianapolis and David Ransohoff of the University of North Carolina at Chapel Hill wrote in a perspective last year.

The IOM hopes its new reports will improve policy making. A workshop to discuss the recommendations will be held in May.

Image: NIEHS

Posted on behalf of Laura Starr

The world’s largest drug maker, Pfizer, has abandoned its efforts in the development of medicines for heart disease in favour of more profitable conditions. This news is getting a load of media attention within the US

(Boston Globe, Reuters). This step is only one of many in a re-shuffle of the company’s research and development activities.

Cuts are also being made in other research disciplines, such as obesity and bone health. The head of research and development at Pfizer, Martin Mackay, told the Wall Street Journal that these are “just not as valuable as other programs, like Alzheimer’s or oncology.” Other future research interests lie in the fields of pain, inflammation, diabetes and schizophrenia.

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