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Reforms Needed for Medical Guidelines?

Institute of Medicine Wants National Board to Review New Medical Recommendations
By
WebMD Health News
Reviewed by Louise Chang, MD

Jan. 25, 2008 -- Congress should create a new national board to help America's doctors and patients digest the dizzying volume of medical studies published each year, an Institute of Medicine (IOM) report recommends.

Insurance companies, hospitals, and medical societies churn out numerous sets of guidelines each year. Those guidelines help direct doctors on how patients should be treated according to available scientific information.

The problem is that the guidelines "are all over the map right now," says Arthur Levin, MPH, director of the Center for Medical Consumers and a member of the IOM panel that wrote the report.

The report calls for a single board in charge of reviewing scientific research and identifying gaps in knowledge. The board would also set standards for anyone who creates medical guidelines.

Levin says it's part of an effort to improve transparency, so that doctors and patients can make better use of recommendations that can now be confusing.

"Is the best treatment for prostate cancer surgery? Well, the surgeons say that. Is it radiation? Well, radiologists say that. How are patients going to know whom to trust?" Levin tells WebMD.

The panel's report says the board would be able to help iron out differences between guidelines and set priorities for new research.

"It would create a standard so when people say 'X' about a treatment, everyone knows just what 'X' means. That's not the case now," Levin says.

Britain's National Health Service has a similar program called the Database of Uncertainties about the Effects of Treatments (DUETs). Kay Dickersin, PhD, another member of the panel, tells WebMD a recent review of rheumatoid arthritis treatments helped improve care for patients.

Most studies had assumed that the No. 1 concern of arthritis patients is pain. But the panel found that patients also suffered from fatigue, a fact that research had hardly addressed.

"This was very important input," says Dickersin, director for clinical trials at the Johns Hopkins University Bloomberg School of Public Health. "People want a roadmap."

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