I agree fully with Greg.
This is getting ridiculous.
NHS Commissioners are being driven to the wall, and in the face of savage financial cuts looming on the horizon from whichever party comes to power in the forthcoming general election.
Members of this group might like to have a read of the latest 'Therapeutics Initiative Newsletter' from the University of British Columbia, entitled 'Gabapentin for pain: New evidence from hidden data':
http://ti.ubc.ca/letter75
Do Greg and I need to write anything else, in order to prove our point?

Other examples where NHS commissioners are paying through their nose for what are essentially marginally effective drugs include Ezitimibe (they have spent 129 million pounds in England the past two years) because they still have NICE TAGs on them. And this inspite of the fact that Merck and Shering-Plough deliberately withheld unfavourable data from the ENHANCE trial for 2 years, until they were dragged kicking and screaming to the table and forced to reveal the data, when they were threatened with a subpoena from the US Congress. Surely the NICE TAG should have been reviewed after the entire ENHANCE trial data was released unwillingly by the pharma companies!

For the benefit of non-UK members of this Group, a NICE TAG means that NHS Commissioners in England and Wales are legally mandated to fund the new technology guidelines, from their existing healthcare budgets within 3 months of its publication by NICE.

Another example of where NHS commissioners are paying out millions is on Rosiglitazone, which also has a NICE TAG attached to it. The US Senate Finance Committee recently released a 332 page damning report on Avandia (Rosiglitazone) on 20th Feb 2010:

Printer-Friendly Version [28.1 KB]

Staff Report on GlaxoSmithKline and the Diabetes Drug Avandia [23.06 MB]

Senators’ Letter to the FDA with Attachments [5.53 MB]

The Senate Finance Committee Report states ' “Americans have a right to know there are serious health risks associated with Avandia and GlaxoSmithKline had a responsibility to tell them. Patients trust drug companies with their health and their lives and GlaxoSmithKline abused that trust,”. 
“We will continue watching closely and working with the FDA to make sure patients and doctors are aware of the risks associated with Avandia and all drugs so they can make safe and informed decisions when choosing their medicines.”

Is it any wonder that health inequalities in Britain are increasing year on year, inspite of record spending on the NHS during the past 13 years?

Ash
Dr Ash Paul
Medical Director
NHS Bedfordshire
21 Kimbolton Road
Bedford
MK40 2AW
Tel no: 01234795705
Email: [log in to unmask]
 


From: Fell Greg <[log in to unmask]>
To: [log in to unmask]
Sent: Sat, 3 April, 2010 19:54:10
Subject: Re: Do you know good examples where guidelines ignore evidence?

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]>
To: [log in to unmask] <[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.