Professor Guy Maddern, professor of surgery at the University of Adelaide, comments on the ongoing controversy over guideline development (see posts below for more background):
“The nature and content of health care needs to be constantly reviewed. This remains an enormous challenge as the impact of new developments, new understandings of disease and the access to treatment continues to change at a pace that is difficult to stay abreast of.
The recent controversy regarding the link between industry and the guidelines that have been generated on prevention of venous thrombo-embolism typify this dilemma. Ideally this type of review should be fundable from Government sources and therefore independently instigated and reported. I suspect no clinician would have any issue with this.
The problem is Government support for these types of reviews is usually non-existent and, if forthcoming, is slow, bureaucratic and usually under-funded. Industry provides a ready source of support, particularly if a product is associated with the review’s terms of reference.
There is probably little doubt that vigorous and thorough guidelines need to be developed and policed for prevention of deep venous thrombo-embolism in patients. Whether or not the magnitude of the problem is as great as suggested by industry remains controversial, however on any given day in any hospital around Australia there is almost certainly more than one patient who should have been given prophylaxis but failed to receive it. This will inevitably lead to problems but when they occur they are expensive, sometimes catastrophic and certainly preventable.
There is little doubt within the research literature that when studies are supported by industry, the results tend to be more favourable towards the intervention. This is not due to any corruption but rather the nature of the relationship that seems to exist when industry funds research endeavours. It is most likely that a similar bias also occurs when industry favours the review of guidelines although no clear data has ever been generated to support this particular contention.
The only solution is to encourage all agencies to avoid taking industry support for such work. This, however, needs to be matched by greater efforts to acquire Government funding for these endeavours.
The solutions are not easy and not to have guidelines at all is probably worse than to have ones that may be somewhat biased by industry but the ideal should be to have ones completely divorced of industry influence. This could be achieved by either more generous Government funding for such activities or the creation of a pool of funds managed independently and at arm’s length by some form of quasi-Government organisation as currently exists with the TGA and application is made by groups wishing to develop appropriate guidelines and recommendations for national use of drugs or devices.
Health and medical groups must make every effort to avoid linking themselves this closely with industry but, until viable alternatives exist, compromises will be required. Until we achieve the utopian existence it is probably rational to have some guidelines rather than none and every effort should be made to divulge any conflict of interests and industry support that occurs in their generation.”