Clinical Practice Guidelines of dubious ethical values feed malpractices

Clinical guidelines by authors with conflicts of interest = Anti-Evidence Based Medicine. Our latest Right Care blog: http://t.co/Zy3XY7BDok
— Shannon Brownlee (@ShannonBrownlee) June 24, 2013

Shannon Brownlee is the author of "Overtreated. Why too much medicine is making us sicker and poorer." This book is the most significant piece of literature in the academic and social movement that empowers valuable clinical practice. The tweet chosen this week refers to "The Right Care Blog". It is an institutional blog of the "Lown Institute" where Mrs. Brownlee is vice president.

Upon entering the blog, you will see that the recommended post is "Conflicted guidelines breed conflicted practice", a text that comments on an article by Jeanne Lenzer in the BMJ, where it is argued that the connivance between the promoters of clinical practice guidelines and the industry are feeding inadequate practices. And to illustrate it, the author selects two examples that have experienced these problems with negative health outcomes of affected patients. One example is TPA, a clot solvent, and the other a recommendation of high dose of corticosteroids for the treatment of spinal cord injuries.

Now that there are many people and many institutions involved in making possible the practice of evidence should reach all corners of the system, it is relevant that there aren’t any ethical questions about the scientific basis of clinical practice.


Jordi Varela

Editor

Less is more: "Overtreated" by Shannon Brownlee

The campaign "Too much medicine" by the British Medical Journal wants to highlight the threat of over diagnosis to the health of individuals, and also expose the inherent waste of resources involved in inappropriate clinical practice. According to the BMJ, there is evidence that more and more people suffer from over diagnosis and overtreatment for a wide range of clinical circumstances such as cases of asthma, chronic renal failure or prostate and thyroid cancer. Through this campaign, the magazine plans to improve awareness among physicians of both the benefits and side effects of treatments and technologies, and thus find out how excesses can be reduced safely and properly.

The editor of the BMJ, Fiona Godlee, gives much attention to the campaign: “As medicine based on evidence, or clinical safety, were the movements of the previous decades, combating excess is a contemporary manifestation of an ancient desire: no harm when we want to heal".

To start talking about this campaign, I thought it would be appropriate to review the book “Overtreated" whose author, Shannon Brownlee is a science journalist who has published in Atlantic Monthly, New York Times, New Republic and Time.

Too much medicine

This is the title of the first chapter of the book, where she writes: “As most clinical practices have never been scientifically proven, when someone was faced with them, it turned out that many of them did not offer a good balance between damage and benefits, they only believed it and let’s review some clinical activities that, having had their base in the moment that have been evaluated, had to be rethought seriously such as tonsillectomies, hysterectomies, frontal lobotomies, radical mastectomies, arthroscopies knee arthritis, radiological screening for lung cancer, inhibitors of proton pump for stomach ulcers, menopause hormone therapy, high-dose chemotherapy for breast cancer, etc."