analysis of clinical practice guidelines archived on the National Guideline
Clearinghouse (NGC) website as of June 2011 demonstrated poor compliance with
Institute of Medicine (IOM) standards, with little if any improvement over the
past 2 decades, say authors of an article published this month in Archives
For the study, 2 reviewers independently screened 130 guidelines selected at
random from NGC's website for compliance with 18 of 25 IOM standards.
The overall median number of IOM
standards satisfied (out of 18) was 8 (44.4%). Fewer than half of
the guidelines surveyed met more than 50% of IOM standards. Barely a third of
the guidelines produced by subspecialty societies satisfied more than 50% of
the IOM standards surveyed.
Information on conflicts of interest was given in fewer than half of the
guidelines surveyed. Non-English literature, unpublished data, and/or abstracts
were rarely considered in developing guidelines. Differences of opinion among
committee members generally were not aired in guidelines. Benefits of
recommendations were enumerated more often than potential harms. Guidelines
published from 2006 through 2011 varied little with regard to average number of
IOM standards satisfied.
everywhere is developing guidelines and there is no real quality control,"
lead author Philip A. Mackowiak, MD, told Reuters
"There is no good oversight of who actually develops the guidelines or
what criteria need to be met in order for them to be published."
IOM's standards were not published until 2011. Mackowiak acknowledges that
the experts who developed the guidelines reviewed by his team would not have
been able to use IOM's standards. However,
he added that similar standards have been published before and that they were
basic enough that they should have been followed, says Reuters.