For those who haven’t read, the recent New York Times article, "Plenty of Guidelines, but Where's the Evidence?" by D. Sanghavi, M.D., I suggest you check it out. Sanghavi discusses the problems caused by centralized guidelines in medicine particularly when there is an evidence gap—when guidelines are based on opinion rather than a careful review of all of the evidence. And, this issue of centralization of medicine through guidelines is becoming more important as the push for national health care heats up.

For those who haven’t read, the recent New York Times article, “Plenty of Guidelines, but Where’s the Evidence?” by D. Sanghavi, M.D., I suggest you check it out.    Sanghavi discusses the problems caused by centralized guidelines in medicine particularly when there is an evidence gap—when guidelines are based on opinion rather than a careful review of all of the evidence.  And, this issue of centralization of medicine through guidelines is becoming more important as the push for national health care heats up.  Sanghavi’s article can be found here.

The notion that guideline recommendations based on “expert opinion” can be used to limit the independent clinical judgment of physicians is of great concern because a small panel that has never seen the patient may be able to restrict individualized care.  Good medical guidelines do not restrict patient treatment options solely on the basis of expert opinion.  The IDSA guidelines on the treatment of Lyme disease not only fail to provide treatment options, they fail to even acknowledge that other treatment approaches exist. The majority of their recommendations (38 of 71) were based on no more than “expert opinion”.  This is, of course, the worst of both worlds, opinion based medicine that interferes with patient care.    

And, the guidelines panels that replace physician clinical judgment may be small and may not reflect all viewpoints.  For example, the Connecticut Attorney General’s investigation of the IDSA found that the chairman of its 2006 Lyme disease guidelines panel, Dr. Wormser, was selected inappropriately, “held a bias regarding the existence of chronic Lyme” and “handpick[ed] a likeminded panel without scrutiny by or formal approval of the IDSA’s oversight committee.” Imagine if the guidelines for prostate cancer were written only by surgeons and precluded other treatment options like watchful waiting, radiation, and hormone therapy.  Opinions, no matter how strongly held, should not foreclose treatment options.  Patient care should not take a back seat to the competitive jostling among medical societies for professional turf.