Thanks Tom,
The GOLD initiative says "Who Are We? GOLD was launched in 1997 in 
collaboration with the National Heart, Lung, and Blood Institute, 
National Institutes of Health, USA, and the World Health Organization. " 
but then if you go to the sponsors page there is a long list of 
pharmaceutical companies. On a plus note, it does recommend pulmonary 
rehabilitation but does not cite the Cochrane review. In fact, among its 
447 references there is only one or the dozen or so Cochrane reviews 
relevant to COPD.
Cheers
Paul


Tom Jefferson wrote:
> Hi all. Influenza diagnosis, prevention and treatment is another 
> example of a chiasm (perhaps a fission) between what the evidence 
> shows and what WHO/CDC etc recommend. Even the UK NIHR/NHS follow and 
> they are the people who paid for the Cochrane reviews and their 
> updates in the first place!
>
> As far as GOLD guidelines are concerned, the latest English version I 
> have seen had a placebo methods chapter and were wholly financed by 
> industry.
>
> Are we talking about the same set of GL?
>
> All the best,
>
> Tom.
>
> On 4 April 2010 22:45, Djulbegovic, Benjamin <[log in to unmask] 
> <mailto:[log in to unmask]>> wrote:
>
>     Indeed, Ash
>
>     But the IOM recommendations (despite its prestige) are
>     non-binding. In addition, some organizations [e.g. NCCN-a
>     consortium of leading 21 cancer institutions in the US-  that has
>     developed widely used cancer guidelines  are on the record to say
>     that “the experts know the best” (based on the premise that it
>     would be unlikely that the best people in the field would not know
>     of the important evidence in their specialty)…and do not endorse
>     the use of SR/MA in development of the recommendations…(although
>     individual panel members are at liberty to use SR/MA as they see
>     it fit)…one argument used against mandating SR/MA is that it is
>     time-consuming to produce, and often are old by the time
>     guidelines are developed…this may be the reason why NCCN, for
>     example, is able to update the guidelines on the annual basis with
>     the input from 21 institutions…]
>
>     Best
>
>     ben
>
>     * *
>
>      
>
>     *From:* Ash Paul [mailto:[log in to unmask]
>     <mailto:[log in to unmask]>]
>     *Sent:* Sunday, April 04, 2010 2:47 PM
>     *To:* Djulbegovic, Benjamin; [log in to unmask]
>     <mailto:[log in to unmask]>
>
>     *Subject:* Re: Do you know good examples where guidelines ignore
>     evidence?
>
>      
>
>     Dear Ben,
>
>      
>
>     That should, logically, no longer be the case, because for the
>     first time ever, in January 2008, in the history of
>     evidenced-based medicine in the USA, the respected Institute of
>     Medicine (IOM) published a document entitled 'Knowing What Works
>     in Health Care: A Roadmap for the Nation', which unequivocally
>     states 'SYSTEMATIC REVIEW: THE CENTRAL LINK BETWEEN EVIDENCE AND
>     CLINICAL DECISION MAKING'
>
>      
>
>     Report Brief (PDF
>     <http://www.iom.edu/%7E/media/Files/Report%20Files/2008/Knowing-What-Works-in-Health-Care-A-Roadmap-for-the-Nation/KnowingWhatWorksreportbriefFINALforweb.ashx>)
>
>
>      
>
>     Report Brief: Developing Trusted Clinical Practice Guidelines (PDF
>     <http://www.iom.edu/%7E/media/Files/Report%20Files/2008/Knowing-What-Works-in-Health-Care-A-Roadmap-for-the-Nation/KnowingWhatWorksCh5.ashx>)
>
>
>     ------------------------------------------------------------------------
>
>     Report Brief: Systematic Review (PDF
>     <http://www.iom.edu/%7E/media/Files/Report%20Files/2008/Knowing-What-Works-in-Health-Care-A-Roadmap-for-the-Nation/SystematicReviewreportbriefSYSTEMATICREVIEW.ashx>)
>
>      
>
>     http://books.nap.edu/openbook.php?record_id=12038 
>
>      
>
>     Respected US clinicians of integrity like yourself and many others
>     from this Group, need to have the courage to put your heads over
>     the parapet and be counted, because unless you all do that, no one
>     (especially big pharma and manufacturers of medical devices) is
>     going to listen to us poor healthcare commissioners bleating away
>     pathetically in the wilderness of the desert of evidenced-based
>     medicine.
>
>      
>
>     Regards,
>
>      
>
>     *Ash*
>
>     Dr Ash Paul
>     Medical Director
>     NHS Bedfordshire
>
>     21 Kimbolton Road
>
>     Bedford
>
>     MK40 2AW
>
>     Tel no: 01234795705
>
>     Email: [log in to unmask]
>     <mailto:[log in to unmask]>_
>
>      
>
>      
>
>      
>
>      
>
>     ------------------------------------------------------------------------
>
>     *From:* "Djulbegovic, Benjamin" <[log in to unmask]
>     <mailto:[log in to unmask]>>
>     *To:* [log in to unmask]
>     <mailto:[log in to unmask]>
>     *Sent:* Sun, 4 April, 2010 19:18:37
>     *Subject:* Re: Do you know good examples where guidelines ignore
>     evidence?
>
>     Hi Paul,
>     The tricky part is how we define/estavlish that guidelines ignore
>     evidence- many prominent guidelines panels do not require use of
>     systematic reviews as a basis for making its recommendations. In
>     addition, generation of evidence is moving target- I have
>     certainly served on the guidelines panels only to learn that a new
>     evidence was published at the time when the guidelines were released.
>
>     Nevertheless, selective citations continue to reign the guidelines
>     recommendations process. Here is one example from my field- this
>     meta-analysis has been ignored by several panels (including the
>     one on which I have served!!). In addition, this systematic review
>     could not affect the reimbursement policy (In the US, autologous
>     transplant is approved for myeloma by the public payer, CMS only
>     in patients with chemoresponsive disease. As discussed in the
>     paper, this requirement is not supported by evidence. In
>     continuation of the cascade of the "herd" behavior, (some)
>     guidelines panels built this requirement in their recommendations
>     in order to match the CMS criteria! BTW, the most famous example
>     of the herd behavior is promotion of the diet pyramid modifying
>     intake of fats vs. carbohydrate. The minority of people (<10%) who
>     challenged the wide promotion of the pyramid diet in 1970s were
>     ostracized for their views).
>
>     Best
>
>     ben
>
>
>     Benjamin Djulbegovic, MD, PhD
>     Professor of Medicine and Oncology
>     University of South Florida & H. Lee Moffitt Cancer Center &
>     Research Institute
>     Department of Medicine
>     Chief, Division of Evidence-based Medicine and Health Outcomes
>     Research
>     Co-Director of USF Clinical Translation Science Institute
>     Director of USF Center for Evidence-based Medicine and Health
>     Outcomes Research
>
>
>     -----Original Message-----
>     From: Evidence based health (EBH)
>     [mailto:[log in to unmask]
>     <mailto:[log in to unmask]>] On Behalf Of Paul
>     Glasziou
>     Sent: Saturday, April 03, 2010 12:01 PM
>     To: [log in to unmask]
>     <mailto:[log in to unmask]>
>     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.
>
>      
>
>
>
>
> -- 
> Dr Tom Jefferson
> Scientific Editor PLoS ONE
> Reviewer, Cochrane Acute Respiratory Infections Group
> tel 0039 3292025051
>