Bumps in the Road to New Cholesterol Guidelines
By GINA KOLATA, NYT
It was supposed to be a moment of triumph. An august committee had for the first time relied only on the most rigorous scientific evidence to formulate guidelines to prevent heart attacks and strokes, which kill one out of every three Americans. The group had worked for five years, unpaid, to develop them. Then, at the annual meeting of the American Heart Association, it all went horribly awry.
Many leading cardiologists now say the credibility of the guidelines, released Nov. 14, is shattered. And the troubled effort to devise them has raised broader questions about what kind of evidence should be used to direct medical practice, how changes should be introduced and even which guidelines to believe.
“This was a catastrophic misunderstanding of how you go about this sort of huge change in public policy,” said Dr. Steven Nissen, a Cleveland Clinic cardiologist who is a past president of the American College of Cardiology. “There will be a large backlash.”
What went wrong? Some critics say the drafting committee mistakenly relied only on randomized controlled clinical trials, the gold standard of medical evidence, but ignored other strong data that would have led to different conclusions. The group’s efforts were severely underfunded. And it announced fundamental changes in medical practices without allowing a public debate before its guidelines were completed.
(More here.)
It was supposed to be a moment of triumph. An august committee had for the first time relied only on the most rigorous scientific evidence to formulate guidelines to prevent heart attacks and strokes, which kill one out of every three Americans. The group had worked for five years, unpaid, to develop them. Then, at the annual meeting of the American Heart Association, it all went horribly awry.
Many leading cardiologists now say the credibility of the guidelines, released Nov. 14, is shattered. And the troubled effort to devise them has raised broader questions about what kind of evidence should be used to direct medical practice, how changes should be introduced and even which guidelines to believe.
“This was a catastrophic misunderstanding of how you go about this sort of huge change in public policy,” said Dr. Steven Nissen, a Cleveland Clinic cardiologist who is a past president of the American College of Cardiology. “There will be a large backlash.”
What went wrong? Some critics say the drafting committee mistakenly relied only on randomized controlled clinical trials, the gold standard of medical evidence, but ignored other strong data that would have led to different conclusions. The group’s efforts were severely underfunded. And it announced fundamental changes in medical practices without allowing a public debate before its guidelines were completed.
(More here.)
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