Guidelines pushing ‘epidemic of misinformation’ on to GPs, warns cardiology expert

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GPs and patients are being put at risk by guidelines because of an ‘epidemic of misinformation’ generated by the pharma industry in collusion with the medical community, a leading cardiologist has warned.

In a packed session on clinical guidelines at Pulse Live this morning, Dr Aseem Malhotra, a consultant cardiologist in London, said: ‘The reality is we have an epidemic of misinformed doctors and misinformed patients.’

Dr Malhotra said this was the result of ‘biased scientific research and biased reporting in medical journals’, as well as commercial conflicts of interest, defensive medicine and lack of training for doctors in how to interpret the research data.

Dr Malhotra added: ‘Regulators fail to prevent misconduct by industry, and that doctors, institutions and journals with a responsibility to patients and scientific integrity collude with industry for financial gain.’

Highlighting the recent controversy over NICE’s decision to promote putting millions more patients on statins, Dr Malhotra said there were still huge doubts about the efficacy of the drugs and their real side-effects.

He said GPs should advise patients that even on the available evidence, the number needed to treat with statins to prevent or delay one death ‘is infinity’ as no benefit mortality has been shown, while a recent independent evaluation found the drugs were of no benefit – even for secondary prevention.

By contrast, Dr Malhotra said that a Mediterranean diet had been shown to have the best evidence for prevention in people with stable heart disease, ‘but nobody knows this’.

Also speaking at the session, Dr Dermot Ryan, a GP in Loughborough and honorary research fellow at the University of Edinburgh, criticised NICE’s approach to developing guidance – in particular for only including evidence from trials that ‘exclude 97% of patients’.

Dr Ryan added: ‘They construct guidelines from abstract evidence and then apply it to a population that was completely excluded from the trials.’

He called for a greater emphasis on pragmatic trials data, as well as for shared decision making in guidance to help GPs deal with the complex patients in their care.

Dr Zoe Norris, a GP in Hull and lead member of the campaign group GP Survival, warned the guidelines were preventing GPs from using their judgement and driving them to practise ‘defensively’ because of medicolegal fears.

Dr Norris said: ‘Clinical judgment is what we are meant to be using – and that does seem to be stressed more and more – but then our hands are tied by referral criteria.’

She added: ‘What worries me that no one is looking at the system, nobody is looking at the reality of implementing this on the ground.’

Speaking from the floor, Dr Adam Firth, Cheshire GP and advisor on the recently published NICE guidelines on end-of-life care, defended NICE’s processes for evaluating evidence which he said were ‘very transparent’.

He added that ‘shared decision making is referenced in every clinical guideline NICE produces’.

But GPs in the audience voted overwhelmingly in support of the question posed at the end of the discussion, ‘Is impractical clinical guidance putting patients and doctors at risk?’