Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Judging a guideline just by financial interest is intellectually lazy

Robert Donnell, MD
Physician
October 27, 2011
Share
Tweet
Share

Tom Sullivan, blogging over at Policy and Medicine, recently noticed another flurry of activity in the long running debate about conflicts of interest. His post is titled Coordinated Ad Hominem Attacks on Physician-Industry Relationships in Guideline Development: The Next Frontier?

He opens, saying, “Recently, we saw concerted attacks on clinical guidelines committees, but interestingly, not on the science coming out of them. Instead, the attacks were focused on whether the writers of those guidelines have a financial interest in the area they are working in.”

That, I believe, is the crux of the whole debate. There has been a lot of criticism of practice guidelines based entirely on the financial interests of the guideline writers. I agree with Sullivan that it really is an ad hominem attack (and therefore fallacious) because virtually all of the criticisms of guidelines that have been written are based not on the science or the primary sources referenced in the guidelines but on the company they keep. I have read many such attacks. Not a single one that I can recall referenced the actual science. The recent examples cited by Sullivan are true to form.

As responsible clinicians we have an obligation to be scholars. That means being familiar with scientific underpinnings derived from primary sources. It’s the only frame of reference we should be using. The arguments of the guideline attackers, devoid of any scientific appeal, always come up empty. More than that, they fail to take into account patient outcomes. Study after study has shown improvement in important patient outcomes, including mortality, associated with adherence to a variety of guidelines. Of scores of guidelines in existence only two have been associated with negative outcomes. (In the case of one of these the flaw is well understood, and known not to be related to industry influence).

I’m not suggesting we follow guidelines uncritically. That would be a violation of the first principles of evidence based medicine, which appeal to the primary evidence and ask the clinician to apply this evidence to individual patient attributes. But there’s noprinciple of evidence based medicine that tells us to first drop down to the bottom of a scientific paper or guideline document, look at the author’s disclosures then either believe it or reject it based simply on that.

You can’t trust a guideline implicitly but the remedy for that problem is to go to the primary sources and look at the actual science. The Internet is easy to use and PubMed is free. To judge a clinical guideline by the simple litmus test of financial interest is not only an ad hominem fallacy, it is intellectually lazy.  We need to do better.

Robert Donnell is a hospitalist who blogs at Notes from Dr. RW.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Stop paying for tests that don't improve health

October 27, 2011 Kevin 6
…
Next

Why hospitals and physicians should get serious about patient-centered care

October 28, 2011 Kevin 53
…

Tagged as: Primary Care, Specialist

Post navigation

< Previous Post
Stop paying for tests that don't improve health
Next Post >
Why hospitals and physicians should get serious about patient-centered care

ADVERTISEMENT

More by Robert Donnell, MD

  • When medical coders blame physicians

    Robert Donnell, MD
  • What to do when a patient wants to leave the hospital against medical advice

    Robert Donnell, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Where has evidence based medicine taken us in 20 years?

    Robert Donnell, MD

More in Physician

  • How transplant recipients can pay it forward through organ donation

    Deepak Gupta, MD
  • A surgeon’s testimony, probation, and resignation from a professional society

    Stephen M. Cohen, MD, MBA
  • Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine

    Trevor Cabrera, MD
  • Collective action as a path to patient-centered care

    American College of Physicians
  • Portraits of strength: Molly Humphreys and the unseen women of health care

    Ryan McCarthy, MD
  • When embarrassment is a teacher in medicine

    Vijay Rajput, MD
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Why AI in health care needs stronger testing before clinical use [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI is reshaping preventive medicine

      Jalene Jacob, MD, MBA | Tech
    • How transplant recipients can pay it forward through organ donation

      Deepak Gupta, MD | Physician
    • Inside the high-stakes world of neurosurgery

      Isaac Yang, MD | Conditions
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Why AI in health care needs stronger testing before clinical use [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI is reshaping preventive medicine

      Jalene Jacob, MD, MBA | Tech
    • How transplant recipients can pay it forward through organ donation

      Deepak Gupta, MD | Physician
    • Inside the high-stakes world of neurosurgery

      Isaac Yang, MD | Conditions
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...