Corruption of science: Treatment guidelines lacking in evidence and riddled with conflicts of interest

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Medical research is a huge industry churning out scientific papers at quite a rate. How are doctors supposed to keep up and know what is deemed the 'appropriate' treatment for a condition? A supposed helping hand comes for doctors in the form of 'clinical guidelines' which can come from a variety of sources including one or more of the relevant professional college or society. However, a recent article in the British Medical Journal casts considerably doubt on the reliability of these reports. The article, written by medical investigative journalist Jeanne Lenzer, focuses on the drug alteplase, a clot-busting drug given for acute stroke. Earlier this year, three US professional societies recommended use of the drug. However, it turns out that only two of the 12 studies on the drug found any benefit, and five of them had to be stopped early due to the finding of a lack of benefit, increased risk of brain haemorrhage or increased death rates. So, how come the guidelines are at such variance with the science? Well, according to ms Lenzer: "Proponents of alteplase have launched projects to ensure uptake of the guidelines in the US, such as the development of "stroke certified hospitals," which require hospitals to commit resources to enable rapid administration of alteplase to eligible stroke patients. Since ambulances divert patients with suggestive symptoms to stroke certified hospitals, the project has substantial financial ramifications. These efforts, and others like the "Brain Attack" campaign, have been actively supported by the American Heart Association and American Stroke Association, which "partnered" with the Joint Commission (a quasi-governmental agency that accredits hospitals) to promote hospital stroke certification. Genentech, Boehringer Ingelheim and Novo Nordisk, which market alteplase, have contributed tens of millions of dollars to the associations."
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