Thursday, April 5, 2018

Very Brief Blog: New Article Reviews History of NIH Guideline Committees 1977-2013

Anyone working on healthcare coverage knows that guidelines have become more and more important; "payers will talk to you after you're in the guideline."  At bottom also find an Easter Egg quote from William Harvey.

Annals of Internal Medicine has an article this week by Todd Olszewski of Providence College on the checkered history of guidelines committees aka "Consensus Development Programs" at NIH from 1977 to 2013.   Find the article here.

As Olszewski describes, these NIH panels were efforts to develop consensus guidelines on major medical topics and were developed over several days with presentations, panel discussions, public input, and draft positions (later fully drafted and finalized and published).   The program was wound down around 2011 and completely disbanded by 2013.

Olszewski cites two books on evidence based medicine as a process and guidelines, one of which I've read and one of which is on my bookshelf:  Timmerman & Berg (2003): The Gold Standard: The challenge of evidence based medicine; and Solomon (2015) Making Medical Knowledge.   (Another book of interest, not well known, is Milos Jenicek's "Foundations of Evidence Based Medicine," 2010).

Other Lost Stories of Evidence-Based Medicine History Besides NIH Consensus Committees

Another story of a temporary governmental evidence assessment effort was the Office of Technology Assessment.  It lived from 1972 to 1995.  See its Wikipedia page here, and a scholarly history article by Sadowsky at ASU here.   See recent articles on it from Atlantic (2012, here) and New York Times (2015, here).   Part of its work was medical, Google as: [ "office of technology assessment" medicare ] or here.

Particular to health care, there was a "National Center for Health Care Technology" which produced a particularly horrible report negative to transgender surgery in 1981, used for a CMS NCD (here, here).   (Bizarre these issues are still active in 2018; see March 2018 AMA letter to Department of Defense re transgender issues, here; also here, here.)   See an article on the history of the NCHCT in NEJM, 1982, here, and an old JAMA article, here

My Favorite Quote about Medical Evidence Indeterminancy!

Somewhere over the years I ran into: "Society and Medical Progress," by Bernhard Stern, 1941.  There are these glorious quotes from William Harvey on medical evidence, pp 186-87:
"Scare a day, scarce an hour, has passed since the birthday of the circulation of the blood that I have not heard something for good or evil said of this discovery.  Some abuse it as a feeble infant, and yet unworthy to have seen the light.  Others again thing the bantling deserves to be cherished and cared for.  These oppose it with much ado, those patronize it with abundant commendation.  One party holds that I have completely demonstrated the circulation of the blood by experiment, observation, and ocular inspection, against all force and array of argument.  Another thinks it scarely yet sufficiently illustrated - not yet cleared of all objections.  Detractors, mummers, and writers defiled [the theory] with abuse...The authority of Galen is so great with all, that I have seen several hesitate greatly [even] with the experiment before them."  
He added that "no man over forty was found to adopt the doctrine of circulation of the blood."

Harvey here of course foresee's "Planck's Principle" that scientific ideas flourish only because their opponents eventually die (here).  Cloud copy of Stern 1941 here, see 186-87.

International Journal of Technology Assessment in Healthcare ran a special supplement on "history of HTA" in 2009; here.

Partly for my own reference, I note here that I used to show a series of slides on logic & reasoning & evidence based medicine, citing a number of not too well known authors, Miettinin, Dickinson, Jenicek, whom I was reading at the time; in this old 2012 deck from page 19 fwd.