BY
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
The Center of Disease Control Guidelines Prescription Guidelines most loathed document in American history
Incurable disabled activists have a most welcome advocate Ghanaboy PharmD (will respect his anonymity by using his handle). His YouTube videos are informative, enlightening, educational and troubling, concerning the needless suffering of millions.
There is one in particular that caught our attention regarding the most loathed document in American history — The Center of Disease Control Guidelines Prescription Guidelines.
Flaws highlighted in his excellent video are the low tier evidence scores, the core expert group only having one “pain expert” who is no longer practices medicine.
These suggestions are now being weaponized by all public and private sectors as the law was constructed in an academic standard barely acceptable for a college thesis. Suggestions have always been the keyword.
An “evidence-based guideline” without an evidence base
October 20, 2015
FROM
Robert Twillman, Ph.D., FAPM
Executive Director
American Academy of Pain Management
TO:
The Honorable Fred Upton
Chairman
House Energy and Commerce Committee United States House of Representatives Washington, DC
On September 29 and 30, 2014, the National Institutes of Health held a Pathways to Prevention workshop on The Role of Opioids in the Treatment of Chronic Pain. Prior to this workshop, experts compiled the relevant available evidence through an exhaustive search of the literature.
This compilation formed the basis for scholars who, at the workshop, reviewed the evidence of benefits and harms resulting from the use of opioid treatment for chronic pain. Following the workshop, an unbiased, independent panel developed a report summarizing the current state of affairs with respect to research into the opioid treatment of chronic pain. Perhaps that report, released on October 2, 2015, is best summarized by this statement from its conclusion:
“What was particularly striking to the panel was the realization that there is insufficient evidence for every clinical decision that a provider needs to make regarding the use of opioids for chronic pain, leaving the provider to rely on his or her own clinical experience.”
Despite this statement from the panel’s report, we were struck by the fact that, only three months later, CDC issued its request for applications to develop “an evidence-based guideline”. We wonder how CDC could be calling for an “evidence-based guideline” when the National Institutes of Health, after a considerable investment of time and money, had just concluded that there was, in effect, no evidence.
We also wish to note that a group of pain management experts, led by the Academy’s current executive director, worked with CDC employees in 2012 and 2013 to review existing opioid treatment guidelines, and concluded that all of them were based on very sparse evidence—that they represented “consensus” guidelines, not “evidence-based” guidelines because there was insufficient evidence on which to base a guideline.
In its draft guideline, CDC acknowledges just how weak the evidence is. The draft guideline provides twelve recommendations for prescribers, and rates the evidence base for these twelve guidelines as being of “low quality” in five cases and as being of “very low quality” in seven cases.
Yet, in another puzzling twist, the draft guideline also rates eleven of the twelve recommendations as “strong” and only one as “weak”. In our view, a recommendation based on “low” or “very low” quality evidence should hardly ever be a strong one, as it essentially represents an expert opinion, rather than a conclusion drawn from evidence.
– CONTINUED –
“LACK OF A SUBJECT MATTER EXPERT (SME)”
FOR NOW, YOU ARE WITHIN
THE NORMS
