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Monday, November 26, 2018

Many doctors writing clinical practice guidelines receive undisclosed industry payments, study finds

The "consensus" clinical guidelines which inform clinicians how to provide care in this land has what is called an agreement score and a kappa score. The overall kappa score for all clinical guidelines in the USA is 0.29 (an excellent score is considered 0.8 or higher). That means that no more than 3 persons out of 10 formulating the guidelines agree about the recommendations in the same way. As an analogy, let's say you go out to dinner with a group of 10 friends. All 10 of you agree that you want pizza. Thus, the agreement of what you want is 100%. Now, to decide what type of pizza you desire, the largest "consensus" will determine the type of pizza for all 10 of you. So, 2 want a Greek pizza, 2 a Margherita pizza, 2 a pizza without sauce, 1 a New York-style cheese pizza and 3 a Chicago-style deep dish pizza. The largest consensus for the type of pizza was 3 (deep dish pizza). Thus, the entire table gets deep dish pizza even though the majority, 7 persons out of 10, did not desire this type of pizza. The agreement to get pizza was 100%, but the consensus as to the type of pizza was 30% (kappa). This is how clinical workforces which determine how to treat heart failure, cancer, strokes, COPD and everything else works. Few ever look into the voting records of these guideline workforces, but when done the kappa score is a paltry 0.29. Yet, that becomes the rule of the land. Everyone, medically, gets deep dish pizza although most on the workforce disagreed (silent majority). I suspect there is a better way to do clinical trials and a better way to formulate clinical guidelines.
from Rajesh Harrykissoon, MD