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Most Americans believe that the recommendations their doctors make are based on solid science and that doctors have their patients’ best interests at heart. Doctors frequently use Affordable Care Act guidelines to help them chose what type of care should work best. A paper published by Seminars in Arthritis & Rheumatism exposes serious conflicts of interest found in orthopedic guidelines.

These guidelines are the behind-the-scenes-instruction book that your doctor is supposed to follow to decide what type of healthcare you get. They cover such things as which medication is prescribed if you have osteoarthritis in your knee, what gets injected, or which surgery you undergo. The Affordable Care Act forces the reliance on guidelines to a new level. How well your doctor follows these set instructions is linked to how your doctor gets paid. The recent research paper exposed that the people determining the guidelines aren’t necessarily making decisions based on what’s best for you, but more likely what’s best for them.

The researchers conducted a systematic review of the United States National Library of Medicine to examine all of the recently published orthopedic guidelines on the treatment of osteoarthritis of the hip and knee. The guidelines first were graded based on how solid the scientific evidence was that supported the document. The researchers also examined the conflicts of interest of the doctors writing the guidelines, including whether any unreported conflicts of interest might exist. Researchers discovered that 50 percent of the guideline recommendations for the treatment of osteoarthritis of the hip or knee were based on lower quality evidence. A conflict of interest was determined to exist any time a doctor making a recommendation had accepted money or other goods or services from a company who would financially benefit if the doctor recommended a drug or device sold by the company. Nearly half the guidelines failed to disclose relevant conflicts of interest. Multiple potential conflicts of interest also were discovered, averaging about 30 per guideline.

Conflicts of interest in medicine are ubiquitous and often under-reported by physicians. Revelations of serious conflicts of interest in treatment guidelines for osteoarthritis take on a new meaning now that doctors are increasingly being forced to treat patients based on guidelines. When physicians were free to practice as they saw fit and decide on their own what was best for their patients, the fact that the guidelines were corruptible had far lesser impact.


“Hip and Knee Arthritis Guidelines Lack Science” first appeared as a post on the Regenexx blog.
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