Can medical guidelines adversely affect the health commons?

Abstract

The three objectives of this talk were to

  1. appreciate the mechanisms (chance, onfounding, and bias) whereby guidelines may inadequately interpret & synthesize the evidence
  2. appreciate the adverse health consequences of guidelines
  3. appreciate how the quality of the guideline process may be improved

My take home messages from this presentation were;

  1. guidelines often involve uncritical evaluations of the literature which can provide a veneer of study integrity, objectivity, scientific validity and independence to sometimes questionable evidence
  2. guidelines can also be subject to subjectivity, cognitive biases, and conflicts of interest
  3. poor guidelines can lead to i) acceptance of marginal or ineffective therapies as “standard of care” ii) overtreatment iii) diversion of funds from other worthwhile priorities iv) inhibition local critical evidence assessment, clinical judgement and patient preferences in routine decision making v) provide false certainty removing the impetus for replication studies to resolve residual uncertaintyies
  4. guideline process could be improved by enhancing i) multidisciplinary committee composition (methodologists, economists, multi-stakeholder) ii) transparency iii) the critical appraisal process iv) the management of conflicts of interest

Date
Apr 11, 2022 9:00 AM — 10:30 AM
Location
McGill University
Montreal, QC
Professor of Medicine & Epidemiology

I am a tenured (full) professor with a joint appointment in the Departments of Medicine and Epidemiology and Biostatistics where I work as a clinical cardiologist and do research in cardiovascular epidemiology.