Guiding the guidelines : The Lancet

...Clinical Practice Guidelines We Can Trust is the tandem document from the IOM—tandem in the sense that one of these standards states that a systematic review must precede guideline formulation. The IOM points out that the database of the Guidelines International Network includes more than 3700 guidelines from 39 countries. The standards were formulated to overcome common deficiencies—particularly in bias and how bias is handled—in existing guidelines. These deficiencies include the variable quality of evidence, poorly done systematic reviews, methodology that is not transparent, a development group that does not reflect all stakeholders, and unmanaged conflicts of interest. The IOM recommends that before the development group is formed, conflicts of interest need to be fully disclosed—and their definition includes financial, intellectual, and institutional interests. The prospective panel members should also explain how any conflicts they might have could influence the guideline process. The IOM is clear in some specific areas: members of the group need to divest relevant financial investments they or family members hold, and not take part in advisory boards or marketing activities with relevant companies. Additionally, the chair and co-chairs should have no conflicts of interest, members with conflicts should form a minority, and funders should have no role in guideline development. Overall, tough talk from the IOM—but much needed talk. Apart from expert members in the group, the standards include involvement of patients or their representatives.