Monday, 2 April 2018

Plea for the end of clinical practice guidelines

James McCormack, a professor of pharmacy at British Columbia University, posted on his YouTube channel, a video clip that adapts the song of the Traveling Wilburys group, "End of the Line", to become "End of the Guidelines". The video begins with a scene from “Life of Brian" where the actor Graham Chapman as a fake Jesus Christ, addresses his followers from the window of his house and says: "You are wrong; you have no need to follow me. Follow no one; be yourselves, each of you is a different person."

Broad support from the leaders of the "right care" movement

The video has the support of more than thirty outstanding professionals in the scientific field of "right care", among them, Glyn Elwyn (Darmouth Institute), Paul Glasziou (Bond University), Shannon Brownlee (Lown Institute), Victor Montori (Mayo Clinic), Ray Moyniham and Iona Heath.

Three clear messages: 
  • Sharing clinical decisions with patients should not be an aggregate of clinical practice guidelines, it should be the foundation.
  • Most clinical practice guidelines ignore the values ​​and preferences of patients and don’t provide balanced information on the benefits and harms of diagnostic and therapeutic proposals.
  • Almost all clinical practice guidelines dictate what needs to be done, instead of providing elements to analyse and discuss treatment options.
A recommendation for the editors of clinical practice guidelines

Please, stop writing instructions and offer instead approximate estimates of what could happen if nothing is done and what would happen if you act and, in this case, in addition to the expected results, you should add side effect evaluations, the undesirable effects and costs of each treatment option.

Jordi Varela

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