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Politics of changing clinical guidelines?


Full Member
5+ Year Member
Nov 7, 2015
This might not be the ideal forum for this post, but I'm sure someone on here can refer me to some good literature.

I was wondering if there are any books/memoirs/blog posts by physicians or scientists that discuss the politics of changing clinical guidelines after a large body of evidence has been accumulated. While these efforts are evidence-based, I'm not sure if the bureaucracies that enact change are dependent on scientific consensus alone.

For example, I shadowed a doctor who told me about the current controversy in Sleep Medicine, where CMS appears to have more power than physicians/scientists in setting clinical guidelines. What's fascinating is that the use of AHI to diagnose OSA and even the severity classification (mild/moderate/severe) for OSA were pushed by CMS - not physicians. This is interesting because resistance to change is driven by a cost-cutting incentive, not an old guard of researchers.

Are there any other stories on the bureaucracy of evidence based medicine? It's not breaking news that basic/translational science is slowed by the older generation, but changing clinical guidelines involves stakeholders who aren’t physicians or scientists. Evidence-based medicine is quite young, but I hope there are some stories out there of older physicians who had to wade through politics to push scientific consensus into the clinic.
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