Another bandwagon loses a wheel

This morning's New York Times has an interesting article on a story that is becoming a familiar one: a treatment guideline written by experts morphs into a rule, is applied widely, and bad things happen. Add the catalyst of industry funding (via various financial relationships with authors of the guideline and industry's ability to widely promote the guideline), and a wildfire spreads. In the New York Times piece the treatment guideline focused on tighter control of blood glucose in diabetic patients. Seems like a simple and good idea, but it was obviously complicated, and after deaths were associated with application of the guideline, the guideline was withdrawn. I recently blogged about how Medicare required hospitals to deliver the first dose of antibiotics within four hours of arrival to the Emergency Department for patients with pneumonia. Again, sounds like a great idea, but critics of the idea were ignored, bad outcomes occurred, and the rule was relaxed. An expert quoted in the New York Times today nailed it when he said, “This was a case in which the advocates of a disease got caught up in their disease rather than the interests of patients.”

Those of you who are regular readers of this blog might be having deja vu since a very similar story could be written about testing every patient who enters the hospital for MRSA. One major difference, however, is that states are passing laws to force hospitals to do this. Counterarguments are being ignored, and industry works behind the scenes as a catalyst. A few weeks ago I attended a lecture on treatment of skin infections, which seemed like a unbiased clinical talk until an off-site physician was teleconferenced into the lecture to deliver an infomercial on the Cepheid PCR instrument for rapid detection of MRSA.

Hopefully, someday I'll pick up the New York Times and find the story to be about MRSA testing, which will signal the end of this very strange chapter in the annals of hospital epidemiology.


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