Nasty processes produce nasty guidelines

doi:10.1136/bmj.39325.436667.3A

BMJ 2007;335:463 (8 September), doi:10.1136/bmj.39325.436667.3A

Letters

NICE on childhood UTI

Nasty processes produce nasty guidelines

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

The guideline from the National Institute for Health and ClinicalExcellence (NICE) on urinary tract infections (UTI) in childhood¹was welcomed by the BMJ.² ³ Most readers will assume it wasbased on evidence correctly analysed by medical statisticians,robustly peer reviewed, and openly debated. As this is a controversialsubject, dependent more on small studies than randomised controlledtrials, many will imagine that it represented consensus followingwide consultation, as stated.¹ Sadly, all these assumptionsare wrong.

The NICE guideline committee signed highly restrictive secrecyagreements, and its two paediatric nephrologists did not consultwith the British Association for Paediatric Nephrology, whosemembers hold diverse views. I was a peer reviewer but was nottreated as one. My first draft review identified major flaws,was supported by the association, and delayed publication bysix months. However, I was allowed to see the committee's adjustmentsonly after strong insistence, signing . . . [Full text of this article]

Malcolm G Coulthard, consultant paediatric nephrologist

Royal Victoria Infirmary, Newcastle NE1 4LP

malcolm.coulthard@nuth.nhs.uk

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