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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]> 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]>
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.

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--
Liliya

"Eternity is a mere moment, long enough for a joke." - Hermann Hesse