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From: Paul Glasziou <[log in to unmask]>
To: [log in to unmask]
Sent: Sun, April 4, 2010 5:48:06 AM
Subject: Re: Do you know good examples where guidelines ignore evidence?

Dear Lilya
The NICE guidelines I found (CG58 - Prostate Cancer Diagnosis and Treatment) seems to skirt around the issue of PSA screening or case finding but starts at the decision to have a biopsy!
"To help men decide whether to have a prostate biopsy, healthcare professionals should discuss
with them their prostate specific antigen (PSA) level, digital rectal examination (DRE) findings
(including an estimate of prostate size) and comorbidities, together with their risk factors
(including increasing age and black African and black Caribbean ethnicity) and any history of a
previous negative prostate biopsy. The serum PSA level alone should not automatically lead to
a prostate biopsy."
Is there another guideline on PSA? I also note this was February 2008 - and the 2 large RCTs of screening published in March 2009.
Seems guideline writers have an uphill battle keeping long guidelines up to date!
Thanks
Paul Glasziou


Liliya Bakiyeva wrote:
> NICE guidelines on prostate disease - completely out of tune with the evidence on PSA testing & monitoring.
> NICE guidelines on ECT - only recommend it as a "last resort" treatment and seemingly ignore all the evidence supporting ECT's efficacy in severe/psychotic depression.  Did I mention that these guidelines were put together without any psychiatrists on board?
>
> On 3 April 2010 19:54, Fell Greg <[log in to unmask] <mailto:[log in to unmask]>> wrote:
>
>    CG96 - chron neuropathic pain
>    Section on pregabalin seems like it was written by Pfizer. Seems
>    to completely ignore the cochrane reviews - from which one might
>    infer that gabapentin is just about equally effecacious (oh and
>    much cheaper).
>    That recommendation will cost taxpayers at least £0.5m in our
>    district alone (500k people) -  by directing to pregab when
>    gabapentin might do. Seems like a case of accepting 'a little bit
>    less health for an awful lot less brass'
>
>    Why?
>    Long arm of pharma influence?
>
>    Over emphasis on expert opinion (which can be biased or unbiased)
>    and under emphasis on evidence?
>
>    Underemphasis on resource impact of recomentations. NICE is not
>    responsible for assessing and dealing with the opportunity cost of
>    its recomendations
>
>
>
>    Greg Fell
>    07957 144899
>
>    ----- Original Message -----
>    From: Evidence based health (EBH)
>    <[log in to unmask]
>    <mailto:[log in to unmask]>>
>    To: [log in to unmask]
>    <mailto:[log in to unmask]>
>    <[log in to unmask]
>    <mailto:[log in to unmask]>>
>    Sent: Sat Apr 03 17:00:38 2010
>    Subject: Do you know good examples where guidelines ignore evidence?
>
>    Dear All,
>    Do you have examples of guidelines that appear to ignore or contradict
>    evidence? For example, self-monitoring of blood glucose has been
>    recommended by many guidelines (including ADA and NICE guidelines in
>    2008) despite weak evidence, and in 2007 the DiGEM trial[1] which
>    pretty
>    clearly showed no benefit (and perhaps some harm). We are particularly
>    interested examples that might help us understand *why* some
>    guidelines
>    appear to ignore evidence, but we'd also be interested in studies that
>    simply document the extent to which guidelines use best evidence, e.g,
>    Andy Oxman's 2007 review of WHO guidelines showing that "Systematic
>    reviews and concise summaries of findings are rarely used for
>    developing
>    recommendations." [2]
>    Many thanks
>    Paul Glasziou & Chris Del Mar
>    1. Farmer A et al Impact of self monitoring of blood glucose in the
>    management of patients with non-insulin treated diabetes: open
>    parallel
>    group randomised trial. BMJ. 2007 Jul 21;335(7611):132. Epub 2007
>    Jun 25.
>    (The ADA guidelines were "revised October 2007, published 2008 but do
>    not mention the July 2007 trial; the NICE guidelines mention DiGEM but
>    state it was not published at the time of writing).
>    2. Oxman AD, Lavis JN, Fretheim A. Use of evidence in WHO
>    recommendations. Lancet. 2007 Jun 2;369(9576):1883-9.
>
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>
>
> -- Liliya
>
> "Eternity is a mere moment, long enough for a joke." - Hermann Hesse