Why the desperation?BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3345 (Published 18 August 2009) Cite this as: BMJ 2009;339:b3345
All rapid responses
Dr Moseley’s emotive response to the National Institute for Health
and Clinical Excellence’s (NICE) outrage at the “ousting” of the president
of the British Pain Society explores more constructive ways the society
could have dealt with their views on NICE guidelines concerning the
management of low back pain (1). I have no specific interest in the
management of chronic low back pain and concur with Dr Moseley that where
evidence is lacking, and more trials are feasible, this would seem an
appropriate course of action. However, the letter to which he responded
(2) raised other important issues; including whether not accepting NICE
guidance is the same as not accepting evidenced based medicine, and
concerns were expressed in other online responses regarding the robustness
and accuracy of NICE guidance. It is interesting that none of these
opinions were represented in the print edition of the British Medical
Journal (BMJ). This could be construed as publication bias and does NICE a
disservice by not allowing these concerns to be raised and debated before
a wider audience.
Five of the seven rapid responses (3) to the original letter
expressed concern regarding NICE guidelines, either suggesting a lack of
robustness of some NICE guidance or expressing disagreement with the NICE
implication that to reject a NICE guideline is to reject evidence based
medicine. These included a measured response concerning which trials are
included in NICE guidelines, and a response identifying a guideline on
arteriovenous extracorporeal membrane carbon dioxide removal in which NICE
had mixed up survival and mortality, then, when informed of this, NICE
failed to correct the guideline in a complete or transparent manner.
Despite now having been highlighted in the online BMJ this guidance is
still not fully corrected with a discrepancy in the survival quoted
between the guideline (4) and procedures overview (5). I remain unable to
find an erratum. Of particular concern the leaflet intended for patients
(6), or their relatives, considering this therapy still erroneously states
that in four studies 97/190 patients survived to hospital discharge, when
in fact it was only 81/190. The robustness of NICE guidelines should be
determined by those who use them as well as by those who create them.
Surely, in the interests of a balanced argument, these issues require
1 Moseley GL. Why the desperation? BMJ 2009; 339: b3345.
2 Rawlins M, Littlejohns P. NICE outraged by ousting of pain society
president. BMJ 2009; 339: b3028.
3 http://www.bmj.com/cgi/eletters/339/jul28_3/b3028 (accessed 26th
4 National Institute for Health and Clinical Excellence (NICE).
IPG250 Arteriovenous extracorporeal membrane carbon dioxide removal: Full
guidance, 2008. http://guidance.nice.org.uk/IPG250/Guidance/pdf/English
(accessed 26th August 2009).
5 National Institute for Health and Clinical Excellence (NICE).
Arteriovenous extracorporeal membrane carbon dioxide removal (AV-ECCO2R)
(interventional procedures overview), 2007.
(accessed 26th August 2009).
6 National Institute for Health and Clinical Excellence (NICE).
IPG250 Arteriovenous extracorporeal membrane carbon dioxide removal:
Understanding NICE guidance, 2008.
http://guidance.nice.org.uk/IPG250/PublicInfo/doc/English (accessed 26th
Competing interests: No competing interests