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The End Product: Clinical Practice Guidelines

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Abstract

The ultimate purpose of studies of medical treatments is to provide evidence that will lead to a “best use” of that intervention. The hope is that research can provide an in-depth understanding of a treatment’s risks and benefits, both over the short and long term. The evidence base for any treatment should also provide insight into how a treatment may affect different patient subgroups. For instance, treatment outcomes may differ according to such variables as the severity of the patient’s illness. Expert panels that review the research literature then develop “clinical practice guidelines” (CPGs) for use by the medical community, and in those documents, they can assess the merits of competing therapies. The CPGs are seen as the gold standard of “evidence-based medicine.”

It is difficult to think of any arena involving information about medications that does not have significant industry financial or marketing influences … Such widespread corporate interests may contribute to self-selecting academic oligarchies, narrowing the range of acceptable clinical and scientific information or inquiry.

—David Antonuccio, 20031

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Notes

  1. G. Guyatt. User’s Guides to the Medical Literature: A Manual for Evidence-Based Practice (Chicago: American Medical Association, 2002): xiv.

    Google Scholar 

  2. K. Dickersin. “Evidence based medicine: Increasing, not dictating, choice.” Br Med Journal 334 (2007): s10.

    Article  Google Scholar 

  3. Also see V. Montori. “Progress in evidence-based medicine.” JAMA: The Journal of the American Medical Association 200 (2008): 1814–16.

    Article  Google Scholar 

  4. IOM (Institute of Medicine). Clinical Practice Guidelines We Can Trust (Washington, DC: The National Academies Press, 2011): 4.

    Google Scholar 

  5. T. Shaneyfelt. “Reassessment of clinical practice guidelines.” JAMA 301 (2009): 868–9.

    Article  Google Scholar 

  6. N. Choudhry. “Relationships between authors of clinical practice guidelines and the pharmaceutical industry.” JAMA 287 (2002): 612–17.

    Article  Google Scholar 

  7. S. Norris. “Conflict of interest in clinical practice guideline development.” PLoS ONE 6 (2011): e25153.

    Article  Google Scholar 

  8. A. Shaughnessy. “What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes.” Br Med J 327 (2003): 266.

    Article  Google Scholar 

  9. P. Rothwell. “External validity of randomised controlled trials: ‘To whom do the results of this trial apply?’” Lancet 365 (2005): 82–93.

    Article  Google Scholar 

  10. M. Krahn. “The next step in guideline development: Incorporating patient preferences.” JAMA 300 (2008): 436–8.

    Article  Google Scholar 

  11. C. Chong. “How well do guidelines incorporate evidence on patient preferences?” J Gen Intern Med 24 (2009): 977–82.

    Article  Google Scholar 

  12. American Psychiatric Association, American Psychiatric Association Practice Guidelines, http://psychiatryonline.org/guidelines.aspx//guidelines.aspx/ (April 22, 2012).

    Google Scholar 

  13. P. Bracken. “Psychiatry beyond the current paradigm.” Br J Psychiatry 201 (2012): 430–4.

    Article  Google Scholar 

  14. L. Cosgrove. “Conflicts of interest and disclosure in the American Psychiatric Association’s clinical practice guidelines.” Psychother Psychosom 78 (2009): 228–32.

    Article  Google Scholar 

  15. L. Cosgrove. “The American Psychiatric Association’s guideline for major depressive disorder: a commentary.” Psychother Psychosom 81 (2012): 186–8.

    Article  Google Scholar 

  16. Also see, L. Cosgrove. “Conflicts of interest and the quality of recommendations in clinical guidelines.” J Eval Clin Practice 19 (2013): 674–81.

    Article  Google Scholar 

  17. American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depressive Disorder, third edition (2012): 2–3.

    Google Scholar 

  18. The Carlat Psychiatry Blog. “A new smoking gun in the APA Textbook Fiasco,” April 11, 2011.

    Google Scholar 

  19. House of Commons Health Committee, The influence of the pharmaceutical industry (London: House of Commons, 2005), http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf//pa/cm200405/cmselect/cmhealth/42/42.pdf/ (May 19, 2011).

    Google Scholar 

  20. B. Als-Nielsen. “Association of funding and conclusions in randomized drug trials: a reflection of treatment effect or adverse events?” JAMA 290 (2003): 921–8.

    Article  Google Scholar 

  21. E. Turner. “Selective publication of antidepressant trials and its influence on apparent efficacy.” NEJM 358 (2008): 252–60.

    Article  Google Scholar 

  22. I. Kirsch. “Initial severity and antidepressant benefits.” PLoS Med 5 (2008): 260–8.

    Article  Google Scholar 

  23. J. Fournier. “Antidepressant drug effects and depression severity: a patient-level meta-analysis.” JAMA 303 (2010): 47–53.

    Article  Google Scholar 

  24. L. Bero. “Influences on the quality of published drug studies.” Int J of Technology Assessment in Health Care 12 (1996): 209–37.

    Article  Google Scholar 

  25. A. Rush. “One-year clinical outcomes of depressed public sector outpatients.” Biol Psychiatry 56 (2004): 46–53.

    Article  Google Scholar 

  26. J. Rush. “Sequenced treatment alternatives to relieve depression (STAR⋆D): rationale and design.” Controlled Clinical Trials 25 (2004): 119–42.

    Article  Google Scholar 

  27. J. Van Scheyen. “Recurrent vital depressions.” Psychiatrica, Neurologia, Neurochirurgia 76 (1973): 93–112.

    Google Scholar 

  28. R. Hales, editor, Textbook of Psychiatry (Washington, DC: American Psychiatric Press, 1999): 525.

    Google Scholar 

  29. M. Shea. “Course of depressive symptoms over follow-up.” Arch Gen Psychiatry 49 (1992): 782–7.

    Article  Google Scholar 

  30. G. Fava. “Do antidepressant and antianxiety drugs increase chronicity in affective disorders?” Psychother Psychosom 61 (1994): 125–31.

    Article  Google Scholar 

  31. G. Fava. “Holding on: depression, sensitization by antidepressant drugs, and the prodigal experts.” Psychother Psychosom 64 (1995): 57–61.

    Article  Google Scholar 

  32. R. Baldessarini. “Risks and implications of interrupting maintenance psychotropic drug therapy.” Psychother Psychosom 63 (1995): 137–41.

    Article  Google Scholar 

  33. W. Coryell. “Characteristics and significance of untreated major depressive disorder.” Am J Psychiatry 152 (1995): 1124–9.

    Article  Google Scholar 

  34. El-Mallakh, R. “Tardive dysphoria: The role of long-term antidepressant use in inducing chronic depression.” Medical Hypotheses 76 (2011): 769–73.

    Article  Google Scholar 

  35. J. Davidson. “Effect of Hypericum perforatum (St John’s wort) in major depressive disorder.” JAMA 287 (2002): 1807–14.

    Article  Google Scholar 

  36. M. Babyak. “Exercise treatment for major depression.” Psychosomatic Med 62 (2000): 633–8.

    Article  Google Scholar 

  37. National Institute for Health and Clinical Excellence. Depression: the treatment and management of depression in adults. NICE clinical guideline 90, (London: National Institute for Health and Clinical Excellence, 2009), http://www.nice.org.uk/nice-media/pdf/CG90NICEguideline.pdf//nice-media/pdf/CG90NICEguideline.pdf/ (April 30, 2011).

    Google Scholar 

  38. E. Van Weel-Baumgarten. “NHG standaard eepressie (tweede herziening).” Huisarts en Wetenschap 55 (2012): 252–9.

    Google Scholar 

  39. M. Murphy. “Alternative national guidelines for treating attention and depression problems in children.” Harv Rev Psychiatry 22 (2014): 1–14.

    Article  Google Scholar 

  40. S. Pliszka. “Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder.” J Am Acad Child Adolesc Psychiatry 46 (2007): 894–921.

    Article  Google Scholar 

  41. S. Pliszka. “The Texas Children’s Medication Algorithm Project.” J Am Acad Child & Adolesc Psychiatry 45 (2006): 642–57.

    Article  Google Scholar 

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© 2015 Robert Whitaker and Lisa Cosgrove

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Whitaker, R., Cosgrove, L. (2015). The End Product: Clinical Practice Guidelines. In: Psychiatry Under the Influence. Palgrave Macmillan, New York. https://doi.org/10.1057/9781137516022_8

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