The ACC/AHA Task Force (TF) on Practice Guidelines (GL) convened in Chicago last week to continue its meticulous examination of the process and methodologies for guideline development. This important group, under the leadership of Dr. Alice Jacobs, is committed to rigorous scientific and ethical standards, near-continuous analysis of new studies to keep guidelines current and relevant, and easy accessibility by users. We’ve asked this beleaguered TF to “turbocharge” the GL process to try to keep up with the ever increasing progression of science. (Gird your loins folks, because the National Academy of Sciences says that in the next decade the total body of human science, accumulated from the dawn of humanity to now, will increase by at least 4-7 fold! I know that sounds absurd--unless you’re a Terminator fan who wants to let the machine doctors do their thing for whatever they will be paid then.) 

The point is, how can we keep up? The GLs in the future will be done by benevolent automation I assume. But today, we rely on dedicated volunteers who are already working hard in their day jobs. Asking them to turbocharge is not easy.

Let’s slip back from this transgression from the ‘singularity’ (sentient machine future) to a reality we’re more comfortable with: 54% adherence to GLs and pressure from outsiders (like the IOM) to consider GLs produced by professional societies as perhaps too biased to recognize. We need to be on our toes here. This must remain our AHA-ACC turf.

Our TF rose to the challenge of an uncertain future in my view. We had already decided that those persons with industry conflicts, no matter how dominant in the science of a particular issue, cannot a chair a GL committee, and cannot be panel members without broad disclosure and compelling reason. In the future such individuals may serve only as consultants or testifiers, with no voting privileges, I suspect. We are tightening this up.

In recognition of the critical significance of comparative effectiveness research, members agreed to consider cost and cost-effectiveness whenever relevant and possible in future guidelines. This would not have been considered even 5 years ago. They considered changes to the recommendation language to convey incremental value in comparisons and suggested the addition of health economists and statisticians to the team of contributors. Again, a bold move.  

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