Volume 193 - Issue 1
Acute coronary syndromes: consensus recommendations for translating knowledge into action
Author: Stephen P Fitzgerald
Med J Aust 2010; 193 (1): 550-553. || doi: 10.5694/j.1326-5377.2010.tb03757.x
Published online: 5 July 2010
Published online: 5 July 2010
To the Editor: It seems that the perceived value of invasive therapy for different acute coronary syndromes varies according to how one chooses and values the various trials.1-3 The differing opinions may have been enriched had they not only considered short-term cardiovascular outcome but also weighed quantitatively — in absolute terms — the purported benefits (or lack thereof) of invasive therapy against the immediate complications and the long-term risks and burden of the combined aspirin and clopidogrel antiplatelet therapy usually necessary after stent placement. It may be that with all this information, patients also have a range of opinions regarding benefits and risks.4
It is difficult to deny that cardiologists in general and the industry sponsors of academic cardiology have an enormous vested interest in complicated, expensive therapies. It does not necessarily follow that the current guidelines and their defenders are unduly biased, but nevertheless the conflict of interest should be confronted and addressed, not taken personally, defensively and indignantly.2 Ideally, the guidelines would both be genuine and seen to be so.
For conservative physicians, there is also a conflict of interest of sorts in that a conservative interpretation of the literature supports their practice.
Forge’s suggestions regarding this issue should be taken more seriously.1 This problem of vested interest is, however, not confined to cardiology. Recently, while highlighting vested interest in mammography, Quanstrum and Hayward broadened their scope and suggested that “independent panels of generalists . . . [be] responsible for objectively synthesizing the medical evidence around a given question or process of care”.5
References
- Forge BH. The “Acute coronary syndromes: consensus recommendations for translating knowledge into action” position statement is based on a false premise. Med J Aust 2010; 192: 696-699. 0_BGDDCCAB
- Brieger DB, Aroney CN, Chew DP, et al. Acute coronary syndromes: consensus recommendations for translating knowledge into action. Med J Aust 2010; 192: 700-701. 0_CBBGJEJC
- Thompson PL. The invasive approach to acute coronary syndrome: true promise or false premise [editorial]. Med J Aust 2010; 192: 694-695. 0_CBBIAABI
- Fitzgerald SP, Phillipov G. Patient attitudes to commonly promoted medical interventions. Med J Aust 2000; 172: 9-12. 0_CBBDBIGC
- Quanstrum HQ, Hayward RA. Lessons from the mammography wars. N Engl J Med 2010; 363:1076-1079. 0_CBBDHDAI