Evidence Over Eminence: Rethinking Specialty Guidelines Amid the ATS-IDSA Debate

Le résumé fourni par la source

To the Editor—We read with interest the debate between experts representing the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) regarding community-acquired pneumonia (CAP) guidelines [1, 2]. As members of WikiGuidelines, a nonprofit organization that seeks to transform the process by which clinical guidelines are constructed, we believe both perspectives overlook a more fundamental concern. Professional societies continue to release guidelines containing recommendations based on low-quality, or no, evidence. Indeed, a recent review found that 64% of ATS guideline recommendations were based on low-quality evidence [3]. The IDSA criticizes that practice, but may be throwing stones from a glass tower, given that a 2021 review of all IDSA guidelines found that although 72% of the IDSA's recommendations were strong, 49% were also based on low-quality evidence, and 47% of the strong recommendations were discordant with the strength of evidence [4]. Guideline recommendations are generally treated “as stone tablets descended from the heavens” [5]. Whether intended or not, guideline recommendations create medicolegal standards of care enforced by lawsuits, set standards regarding what clinical care payors will reimburse, enable healthcare regulators to sanction health systems for noncompliance, and can make difficult conduct of clinical trials needed to establish high-quality evidence. History has shown repeatedly that guidelines contribute to healthcare waste and lead to widespread harm when they mandate practices subsequently demonstrated to have been wrong [5].

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.