There's one last form of bias that is worth mentioning and was noted by Wachter et al in an editorial in the Annals of Internal Medicine last year. They criticize a CMS policy that required that the first dose of antibiotics for pneumonia patients be given within 4 hours of arrival to the emergency department. This policy, which was not well thought out, had unintended consequences that ultimately required that the rule be revised. They write:
In addition to financial conflicts of interest, caution should be exercised when individuals are both key investigators and policymakers, particularly when the stakes are high. In the case of TFAD [time to first antibiotic dose], several key researchers had positions with CMS and IDSA and helped drive the conversion of their own studies into performance standards. None of us can be entirely impartial when judging the merits of our own research.
Over five years have elapsed since the SHEA guideline was published. It's time for a new guideline, and SHEA should ensure that the process is open, fair, and includes experts with varying viewpoints on how to control multidrug resistant pathogens.