quinta-feira, 25 de janeiro de 2007

Dirigindo as Diretrizes

O The New England Journal of Medicine publica o artigo Guidance for Guidelines de Robert Steinbrook, questionando os famosos "guidelines" ou diretrizes. Obviamente, o problema maior é a ligação estreita dos autores de diretrizes com a indústria farmacêutica e de equipamentos. Eu não gosto das diretrizes, por esse aspecto e, também por transformar a medicina em prática chata e burocrática. Posso parecer contraditório, mas as diretrizes são muito mais apropriadas às práticas de saúde pública como vacinação, check-up, atendimento de emergência do que à clínica do dia a dia. Abaixo, trecho do texto de Steinbrook.
Guidelines have also been questioned when pharmaceutical and medical-device companies with a financial stake in the outcome provide substantial funding for their development and implementation. When members of guideline committees also have substantial financial associations with industry, further questions inevitably arise. Some argue that public disclosure of sponsorship and of the financial associations of committee members, along with rules to prevent sponsors from influencing the selection of panel members and the content of guidelines, are adequate safeguards. Others maintain that practice recommendations will invariably be viewed with skepticism unless corporate sponsorship and experts with financial ties are completely avoided. At present, the financial ties between guidelines panels and industry are extensive. A survey of 685 disclosure statements by authors of guidelines concerning medications found that 35% declared a potential financial conflict of interest. In 2006, Eli Lilly was criticized for providing the impetus for the development of practice guidelines for sepsis treatment and coordinating the process with a marketing campaign for Xigris (recombinant human activated protein C). And Amgen and other companies that manufacture or market recombinant erythropoietin, as well as DaVita, a large company that provides dialysis services, have been criticized for their close relations to the development of the National Kidney Foundation's guidelines for managing anemia in chronic kidney disease. An alternative approach is government sponsorship, although it does not ensure that committee members are independent of commercial interests. In 2004, the National Cholesterol Education Program updated its guidelines for the detection, evaluation, and treatment of high blood cholesterol in adults. It was subsequently disclosed that most of the committee members had extensive financial connections to the manufacturers of statins, which stood to gain from increased use of these drugs.

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