PerspectivesAre you interested in submitting a Perspective Article? Be sure to read The Science Advisory Board's Editorial Guides for Perspective Articles. Click here. Treatment Guidelines: How Valid and Practical is Their Generalized Use? by Nusrat Shafiq, M.D. and Samir Malhotra, M.D. Treatment guidelines are a comprehensive and instructive guide for physicians to manage their patients. In this era of evidence-based medicine, most of these guidelines are based on results of double-blind, randomized clinical trials. In the case such evidence is not available, guidelines may be based on open-label, nonrandomized studies, or even on case series. These guidelines are often published in premier scientific journals and are accessible to most physicians. The universal endorsement of these guidelines is often not feasible and may even be questionable. The disease patterns may show ethnic variations and so may the drug response. This may make some other therapeutic agent superior to the one advocated in the treatment guideline. However, because of lack of scientific evidence pertinent to such variations, therapeutic guidelines established elsewhere serve as the best option available. Many of the new agents/modalities of treatment incorporated in the guidelines may not be available or may be too expensive to be universally used in developing nations. Moreover, the health budget and health priorities differ from nation to nation. A superior agent may not necessarily be recommended because of such needs. In such situations indigenous guidelines become even more meaningful. Sometimes the treating physician may decide to waiver from the course of action recommended in a particular guideline. This is usually based on personal experience of, say, “many years”. Though practice based on gut feeling and anecdotal evidence should not be encouraged, one has to take this factor into consideration as it may vary from region to region. Hence, guidelines that are more flexible in nature, rather than instructive, should be framed. We also recommend that an ever-evolving system be developed that formulates indigenous guidelines that incorporate the regional nuances of disease, ethnic variations, availability of drugs, healthcare budget, health priorities, physician- and to an extent, patient-preferences. Leading, tertiary-care, teaching institutions having clinical pharmacologists and experienced physicians must take the initiative in establishing these guidelines. ### Dr. Shafiq has been a member of The Science Advisory Board since December 2003 and Dr. Malhotra has been a member of The Science Advisory Board since August 2003. ### << Previous Next >> [ View All Perspectives ] |
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