The result was the NIH Consensus Development Program, which was proposed as a means of allowing "appropriate members of the medical professions, the research community, consumers and others to join in evaluating a technology". The US National Institutes of Health have come under intense political pressure to provide a more formal system of assessment for new developments in medicine that are seen to provide unparalleled opportunities by the medical profession but insupportable burdens by policy makers.
It comes as no surprise that in the USA, by comparison with the UK, more patients will receive more expensive drugs if recommendations are followed, although the guidelines are based on the information. Hypercholesterolaemia2,3 or hypertension4,s provides a revealing insight into the impact of social factors on medical practice.
In some cases national learned bodies have been responsible, and comparison of recommendations by these organisations for management of common conditions such as Consequently, one growth industry of the past decade has been the publication and propagation of guidelines for patient management. How is this done? There seems to be only one answer to such a question: establish a committee to Doctors have If medical care has to meet acceptable standards, standards have to be defined. Both groups now have every inducement to question the activities of those who are responsible for health care. George Bernard Shaw’s1 conspiracy of the professionals against the public is no longer acceptable, either to the public or to governmentsthe former because their personal wellbeing may be at risk, the latter because they see the costs of medical practice escaping from their control. Statutory body entrusted with the task of facilitating and disseminating clinical practice guidelines not only to health-care providers but also to policy makers and the public.8 In one of the latest examples, a multidisciplinary expert panel (physicians, nurses,īeen so exposed to scrutiny.
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