Every year medical journals publish thousands of new research studies, and few doctors have the time or expertise to read them all. To help them, a patchwork of private and public organizations distill these studies into up-to-date clinical guidelines, which are recipes that doctors follow to treat everything from ingrown toenails to heart attacks.
By creating national standards of care, these groups exert great influence over medical practice. Yet the process for creating guidelines can be idiosyncratic and error-prone, especially in regard to children’s health, leading to sudden shifts that confuse doctors and parents.
Over the last year, for example, the American Academy of Pediatrics abruptly reversed its recommendation that healthy infants avoid peanuts and other potential food allergens, without citing any new data. Weeks after the American Heart Association widely publicized the need to perform cardiac testing in children treated with drugs for attention problems, the academy issued a contradictory guideline discouraging such testing.
Last summer, the academy issued a controversial policy statement calling on doctors to check blood cholesterol levels in millions of young children and, in some cases, prescribe chronic drugs to lower cholesterol.
Dr. Roger Suchyta, the academy’s associate executive director, told me the policy was reviewed by 14 committees and the board of directors before publication. But he added that academy standards did not require any systematic overview of the scientific literature before a policy was issued. The policies may thus rely greatly on some doctors’ personal views, not clear data.
In an oversight, the cholesterol policy was not assessed by the American Heart Association or American College of Cardiology, which also issue guidelines. “Nobody thought to do that,” Dr. Suchyta said.
The committee that drafted the policy also had severe time constraints, said one of its members, Dr. Jatinder Bhatia, a neonatologist in Georgia.
The panel must review its policies every five years, and this year it had to consider “a whole bunch of reports,” he told me, including complex policies on infant formula and vitamin supplementation — 1,178 pages in all, of which the cholesterol policy was only 11 pages.
The committee also did not grade the quality of the evidence behind its recommendations, like beginning cholesterol tests in many toddlers as young as 2 and treating children as young as 8 with cholesterol-lowering medications.
A report in The Journal of the American Medical Association found that only about a third of clinical guidelines reviewed current medical evidence. Fewer than half followed any kind of standard format.