Nasty processes produce nasty guidelines

People with ME and Dr Speedy are not the only ones having major problems with NICE guidance at the moment.

Just have a look at the following letter in a recent edition of the British Medical Journal by Dr M G Coulthard, a consultant paediatric nephrologist (kidney specialist) from the Royal Victoria Infirmary in Newcastle NE1 4LP:

“NICE on childhood UTI (Urinary Tract Infections):
Nasty processes produce nasty guidelines

The guideline from the National Institute for Health and Clinical Excellence (NICE) on urinary tract infections (UTI) in childhood was welcomed by the BMJ.

Most readers will assume it was based on evidence correctly analysed by medical statisticians, robustly peer reviewed, and openly debated.

As this is a controversial subject, dependent more on small studies than randomised controlled trials, many will imagine that it represented consensus following wide consultation, as stated. Sadly, all these assumptions are wrong."

The NICE guideline committee signed highly restrictive secrecy agreements, and its two paediatric nephrologists did not consult with the British Association for Paediatric Nephrology, whose members hold diverse views. I was a peer reviewer but was not treated as one.

My first draft review identified major flaws, was supported by the association, and delayed publication by six months.

However, I was allowed to see the committee's adjustments only after strong insistence, signing . . . [Full text of this article].”

A few further comments by other consultant paediatricians or kidney specialists
(see also http://www.bmj.com/cgi/eletters/335/7618/463#176316 ):

"The Most Controversial Guideline Ever Produced."

"Why doesn't NICE seek genuine consensus?"

So as I said before, they call themselves the Institute of Excellence, and now I also know in what.

They are an Institute of Excellence in producing worthless guidelines. And as they are part of the NHS, see their logo, that means the Government is paying them.

Oh dear oh dear.

So are they following the Government’s instructions or are they just pushing their own ideas in the name of so called Evidence Based Medicine, without any open discussion/critique or input from real specialists???

Worthless and full of vested interests is what this is.

A shame really.

Or as another consultant put it: "How much money was spent in formulating these inadequate guidelines? The NICE process does not appear to be very transparent or accountable.

This is a serious issue of national importance - if all NICE committees operate in this way this requires investigation at the highest level if patient care is not to be compromised in the future. "

The Dr Speedy ME Guidelines are a million times better and didn’t cost that much. But critical reading, using REAL experts and using common sense are certainly not the flavour of the month at NICE.