Death Panels Redux: The National Guideline Clearinghouse Edition

So the Trump Administration has decided that evidence-based medicine is stupid (boldface mine):

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse [NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

“Guideline.gov was our go-to source, and there is nothing else like it in the world,” King said, referring to the URL at which the database is hosted, which the agency says receives about 200,000 visitors per month. “It is a singular resource,” King added…

“AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand…

The site plays another critical role, King said: that of gatekeeper. Because medical guidelines are produced by such a vast array of organizations, they vary widely in quality.

“In times past, there were an awful lot of, let me put air quotes around this — ‘guidelines’ — that weren’t of good methodologic quality,” King said. “They were typically just expert opinions, or what we jokingly refer to as BOGSAT guidelines: ‘bunch of guys sitting around a table’ guidelines.”

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies…

Underscoring how medical research like that maintained by the NGC can be politicized, AHRQ drew the ire of then-congressmember Tom Price in 2016 when it published a study critical of a drug manufactured by one of his campaign donors. According to ProPublica, one of Price’s aides emailed “at least half a dozen times” asking the agency to pull the critical research down. Price was the first director of HHS, AHRQ’s parent agency, under the Trump Administration, before resigning under pressure last year over his spending on chartered flights.

The other element of this is the conservative propaganda effort around ‘death panels’, which was a two-for-one deal: it accused the ACA (Obamacare) of mandating ‘death panels’, while, at the same time, undermining efforts to provide reliable, non-corporate funded information about medical procedures and drugs, in part through AHRQ research.

Mission accomplished, as the kids used to say.

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2 Responses to Death Panels Redux: The National Guideline Clearinghouse Edition

  1. Gingerbaker says:

    People who hate government, and do their best to destroy government, are called anarchists.

    • Bern says:

      “People who hate government, and do their best to destroy government, are called anarchists.”
      Hmmm…how do we weaponize this?
      Also too, see http://www.wiredinternational.org/ for another guidelines publishing site. They are doing massively important work getting crucial medical info distributed around the world.
      Disclosure: the founder is a good friend of mine…

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