Healthcare rationing---are additional criteria needed for assessing evidence based clinical practice guidelines?

BMJ 1999;319:1426-1429 ( 27 November )

Education and debate

Healthcare rationing $---$ are additional criteria needed for assessing evidence based clinical practice guidelines?

Ole Frithjof Norheim, associate professor.

Division for General Practice, University of Bergen, N-5009 Bergen, Norway

ole.norheim@isf.uib.no

The first 150 words of the full text of this article appear below.

In 1995 the case of "Child B" reached the headlines of British newspapers and stirred public debate about the decision towithhold a second bone marrow transplant from a child with acutemyeloid leukaemia. ¹ ² The decision was based on the weaknessof scientific and clinical evidence of the treatment's efficacy.It was also argued that the decision was in accordance with guidelinesfor patient selection that were already in place for such specialisedtreatment. A central issue is why judgments such as this are notperceived as legitimate, even when they are based on clinicalguidelines. The explanation may lie partly in the fact that theguidelines used have not been developed through a process consideredas legitimate. Why should the patient, her parents, or the publicaccept some little known guidelines developed within the closedcommunities of medical experts? This issue is valid for all typesof clinical practice guidelines. . . . [Full text of this article]

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