Earlier this year, guidelines from three respected US professional societies advised doctors to give alteplase to patients with acute stroke. The published evidence shows reductions in disability but not in mortality, with only two of the 12 randomised trials showing benefit and five having been terminated early because of lack of benefit, higher mortality, and significant increases in brain haemorrhage. It is hard not to feel a certain fatigue as I relay this information.Lenzer has found that for one of the guidelines recommending alteplase, seven of eight panel members had https://www.data-sys.co.uk ties with industry: three had direct relationships with companies that market alteplase, while four had links with an educational foundation wholly funded by industry, whose president and founder was an outspoken advocate for alteplase on acute stroke.Meanwhile, emergency physicians find themselves ghd rose gold hair straightener
in a difficult position. The guidelines represent the standard ghd serene pearl
of care against which they will be judged in any claims of malpractice. And although the rules on conflict of interest may be tightening, the current standards of care across much of medicine originate with similarly biased guideline panels. Doctors will have to wait for new guidance that they and their patients can trust. Earlier this year, longstanding guidance recommending high dose steroids in acute spinal injury was reversed because of lack of evidence of benefit and clear evidence https://en.wikipedia.org/wiki/GHD of harm. In that case too, as Lenzer reports, the initial guidance was tainted with financial conflicts of interest, and physicians were sceptical based on their own clinical experience with the treatment.So let us put our faith in informed scepticism. Peter Doshi and colleagues have compiled a dossier of trials that have never been published or have been misreported but for which the data are in the public domain through legal proceedings or freedom of information requests.
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