Independent therapeutic advice: How achievable is it?

Abstract

This supplement is likely to be of interest to anyone involved in the development of clinical guidelines and clinical research, including: • health professionals, trainees and students who use guidelines as a basis for their decision making • policy makers and others working to improve the quality of health care • people involved in university, college and hospital education. The supplement outlines the issues discussed at an Independence Forum hosted by Therapeutic Guidelines Limited in Melbourne, Australia, on 29 October 2012. It puts forward recommendations to overcome limitations of the evidence base and improve the trustworthiness of guidelines. Therapeutic Guidelines is an independent, not-forprofit organisation that was established to promote the quality use of medicines through the publication of clear, concise and ready to use guidelines. Therapeutic Guidelines convened the Independence Forum to discuss issues of independence and conflicts of interest in the context of the development of therapeutic guidelines for health professionals. Two eminent overseas speakers, Professor Silvio Garattini from the Mario Negri Institute, Italy, and Assistant Professor Barbara Mintzes from the University of British Columbia, Canada, gave keynote presentations on the complexity of the therapeutic environment and clinical evidence base. Key Australian commentators and health ethicists – Professor Paul Komesaroff from the Centre for the Study of Ethics in Medicine and Society at Monash University, and Associate Professor Ian Kerridge from the Centre for Values, Ethics and the Law in Medicine at the University of Sydney – focused on the influence of vested interests in clinical research trials and guideline development, citing high profile examples such as the case of hormone therapy after menopause. Panel discussions provided insights on these issues from a range of perspectives, including government, evidence-based medicine, clinical research, health professionals and community. During the last session, speakers and participants worked in small groups to formulate recommendations and strategies to improve the suitability of the evidence base and trustworthiness of therapeutic recommendations and guidelines.