More Guideline Controversy: Blood Pressure Expert Decries 'Political Correctness'

Feb 3 2014, 3:58pm CST | by

More Guideline Controversy: Blood Pressure Expert Decries 'Political Correctness'

Now add “political correctness” to the long list of criticisms directed against the recent publication of new and updated cardiovascular guidelines. One leading hypertension expert writes that the authors of the recent AHA/ACC/CDC Science Advisory on blood pressure control were chosen not for their expertise but for political expediency.

Last year the NIH said it would no longer take responsibility for coordinating and publishing its well-established and highly influential cardiovascular guidelines. The American Heart Association and the American College of Cardiology took over this responsibility, but the transition has been filled with controversy and confusion. In November the AHA and the ACC released 4 major cardiovascular guidelines, but one of the most eagerly-anticipated guidelines, the hypertension guideline, was conspicuous by its absence. As a stopgap measure the AHA and the ACC, along with the CDC, released the Science Advisory. This advisory is the subject of the new charge of political correctness. (Subsequently the authors of the original NIH hypertension group published their guideline in JAMA  under their own auspices. But, to add to the confusion, a “minority report” from several of the authors expressed disagreement with one major aspect of the guideline.)

Franz Messerli, the director of the hypertension program at St. Luke’s-Roosevelt Hospital Center in New York City, writes in the journal Hypertension that the 7 authors of the AHA/ACC/CDC advisory are not experts in hypertension. The authors are neither hypertension specialists who have written extensively about the disease, nor have they served on the advisory board of hypertension journals. By contrast, according to Messerli, the authors of the previous NIH-supported hypertension guideline had “extensively published on hypertensive cardiovascular disease ” and were indeed “ true experts displaying skills or knowledge to guide other physicians in detection, evaluation and treatment of patients with hypertension.” Messerli concludes:

On a positive note, compared to the JNC 7 authors, the AHA/ACC/CDC Science Advisory have a much shorter list of conflict of interests and consist of a more diversified group of people. We are not privileged to have access to the selection criteria for the authors of these guidelines. Clearly they must have been other than expertise in hypertensive cardiovascular disease, i.e. “special skill or knowledge derived from training or experience”.

In a response, the presidents of the AHA and the ACC, Mariell Jessup and John Harold, write:

…the writing group members were invited, selected not for purposes of “political correctness,” as Dr. Messerli asserts, but rather to include individuals with credentials and experience, not only in in primary care and cardiology, but also in population health and clinical quality improvement in medical care delivery systems. These persons truly qualify as experts in one or more of these areas, and they represent a diversity of medical specialty, professional setting, gender, and, although not apparent by name alone, racial/ethnic diversity. And as noted by Dr. Messerli, the writing group had few conflicts of interest. The terms “guideline” and “expert” panel were intentionally avoided. Guidelines provide the science base for what needs to be done. This advisory was meant to provide guidance on how to get it done.

They also note that the AHA and the ACC are “in the planning stages” for developing a more comprehensive expert hypertension guideline.

In an interview Messerli said that the composition of the authors of the JAMA hypertension guideline “seems to be acceptable.”

Comment: A careful reading of the AHA/ACC response leads to the inevitable conclusion that Jessup and Harold are not actually disagreeing with Messerli but are instead offering a different interpretation of the same simple and inarguable set of facts. Messerli views these facts as evidence of “political correctness” and therefore, presumably, a bad thing. Jessup and Harold look at the same set of facts and see diversity and inclusiveness, presumably a good thing.

Source: Forbes Business

 
 

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