Eminence-based Medicine?

In Evidence-Based Medicine on March 16, 2009 by Danielle Tagged: , , , , , ,

According to the NICE website, guideline producers should be accredited.

The draft ‘Process manual for accrediting producers of guidance and recommendations for practice: a guide for producers and stakeholders’ describes the process for accrediting producers of guidance and recommendations for practice. It provides details on the scope for accreditation and what types of guidance producers are accredited, the criteria used to perform the accreditation assessment, the main steps in the process for reaching an accreditation decision and the notification and publication process of an accreditation decision.

This draft is out for consultation until 1st May 2009 so you may wish to leave your comments before then.

I witnessed an interesting email exchange in which one person questioned whether applying the ‘seal of recognition’ to institutions rather than individual guidelines, as NHS Evidence will do, was a return to ’eminence-based medicine’ instead of evidence-based medicine.

I think the commentator has a point as, in my experience of guideline-producing organisations, guidelines vary widely based on who is working on them and their commitment to the project.  Staff turnover is a constant threat. Before all that the guideline has to be scoped. If the scope is too broad, then the workload can easily become immense, leading to extra pressure on staff. I will not remark on project management or management of any kind.

I have not yet read the consultation document, but I will, and when I do I will consider how the recommendations affect the people creating the guidelines, running the searches and writing the reviews.  At work, it was often said that a NICE-quality guideline is the equivalent of 15-25 systematic reviews, yet the entire process takes 18 months with no ‘wiggle room’ for sick leave or annual leave.

The commentator suggests that the new recommendations seem ‘rigorous if time-consuming’.  In my personal opinion, I was always amazed that only one research fellow was assigned to each guideline, given the workload. Perhaps the consultation contains guidelines for increased staffing as well?


5 Responses to “Eminence-based Medicine?”

  1. […] Read more: Eminence-based Medicine? « (the) illness informaticist […]

  2. […] Read a original: Eminence-based Medicine? « (the) illness informaticist […]

  3. “Eminence based medicine.”


    Wish I had thought of that one.

    • So do I, Charles. That honour goes to Stephen Ayre, who responded to the email about the NHS Evidence accreditation scheme that was sent to the UK Health libraries group.


  4. I think this is a really important issue and it will be interesting to see how NHS Evidence will work in practice. Eminence-based Medicine strikes back. Also, even if you do get over this problem of rating institutions, many “producers of guidance” publish different types of product (look at NICE for example), and their different products might be worthy of alternative levels of accreditation. I wonder if it will all become a bit of a mess?

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