|ALMOST HALF HEART GUIDELINES NOT SCIENTIFIC|
Tricoci P, Allen JM, Kramer JM, et al. Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines. JAMA 2009 Feb 25;301(8):831-841.
It's common to hear medical practitioners with absolutely no professional nutrition training proclaim that 'supplement use isn't based on scientific research". This report in JAMA suggests the same could be said for the heart guidelines cardiologists use. Actually, almost half of the guidelines issued to cardiologists by the country's leading heart organizations are based on low levels of evidence, according to this study.
Dr. Pierluigi Tricoci and his co-authors reached their conclusion after examining more than 20 years worth of practice guidelines published by the American Heart Association and the American College of Cardiology. They looked at the levels of evidence -- A, B or C, with A being the strongest and C being the weakest. In the 16 lists of guidelines that report levels of evidence, only 314 of 2,711 recommendations -- less than 12% -- are classified as level of evidence A, compared to 1,246, or 48%, that are level of evidence C, they wrote. A recommendation based on evidence C "has no evidence to support it, other than anecdotal," Tricoci said.
In an damning editorial that accompanied the study, Drs. Terence M. Shaneyfelt and Robert M. Centor, said the most widely recognized bias in guidelines is financial. "Guidelines often have become marketing tools for device and pharmaceutical manufacturers," they wrote. "Only when likely biases of industry and specialty societies have been either removed or overcome by countervailing interests can impartial recommendations be achieved."
In other words, when it comes to practice guidelines for cardiologists, science does not dictate practice. In fact, 4 times as many guidelines had the weakest level of evidence vs. those that had the highest level. And we have prominent physicians stating that the pharmaceutical industry has a huge influence on how guidelines come about.
Who's not scientific now?
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