The sad, scary truth about modern “standards of care”

When I came across this news, I couldn’t waste a second sharing it with you. It’s that important.

According to a recent published analysis, most standard treatment guidelines aren’t based on rock solid evidence. Even worse, the people who determine these standards often have conflicts of interest that influence their recommendations.

It’s sad, scary, and totally true. A team of researchers recently assessed the validity of guidelines featured issued by several medical societies. These included the American Association for Bronchology and Interventional Pulmonology, the American Society of Diagnostic and Interventional Nephrology, the American Society for Gastrointestinal Endoscopy, and the Society for Cardiovascular Angiography and Interventions.

Now, I hate to throw statistics at you. But these numbers are eye-opening, to say the least. So here goes.

Less than half of the associations bothered to take quality of evidence into consideration when creating their guidelines. And there were obvious conflicts of interest behind more than 90 percent of the guidelines the researchers analyzed.

In fact, there was an average of 5.8 conflicts per author . How’s that for a “standard of care”?

This is an enormous problem. And we all need to start paying attention to it. Because these guidelines are being used to determine what kind of treatment you’re getting, how much of it you’re getting, and also what your insurance company will pay for. (Sadly, that last factor informs treatment choices a lot more than most people might imagine.)

Yes, Big Brother is watching us doctors. And he’s also telling us how to treat our patients. Pretty soon, you probably won’t have a choice in the matter at all. And here’s why.

Once a standard of care is established, your doctor risks a lot if he or she practices outside of those guidelines.

Let’s say, for example, that you’re my patient. And I take you off of a highly toxic statin medication, and ask you to address your condition with lifestyle changes, instead. (My New Hamptons Health Miracle achieves better results than drugs can, anyway.)

Well, believe it or not, this counts as “deviating from the established standard of care.” And, therefore, I am liable for malpractice.

That’s right. I could lose my medical license . Simply because I advised you to eat right instead of prescribing Lipitor.

This example alone should drive home the point of how influential these “official” recommendations and guidelines can be. So when I found out they don’t have high quality evidence to support them–and worse, that these “expert opinions” are teeming with conflicts of interest? Well, I tend to get pretty upset.

And you should, too.

Doctors are being pushed into an even tighter corner, and our ability to think outside the box is being discouraged more and more. So if we’re serious about defending our right to quality care, we need to come together.

We need write to our representatives and tell them we won’t let them bulldoze our health. Or lock down our access to the type of care and treatment we want.

These sentiments are not about the Affordable Care Act. And they’re not a condemnation of any particular political party or person. They’re simply a reflection of the reality we currently face.

And make no mistake. It will affect all of us. Not in a good way, either.

So don’t roll over and play dead. Stand up for your rights. It’s easy to do if you have the internet, or a pen and paper, and a little extra time. You can find your state and local representatives–and their contact information–by visiting and entering your zip code. You can email your representatives any time of the day or night. And I strongly urge you to do so.

Like most urgent health issues, waiting will only make the situation worse. Just do it.


“Systematic analysis underlying the quality of the scientific evidence and conflicts of interest in interventional medicine subspecialty guidelines.” Mayo Clin Proc. 2014 Jan;89(1):16-24.