NICE and Cochrane sign collaborative agreement to deliver ‘living’ guideline recommendations

rest of article here
https://www.wired-gov.net/wg/news.n...guideline+recommendations+01092021120500?open

 

How to brush aside the supposed independence of two organisations in one fell swoop.

 

A lot of scratched backs ?

 

My heart sinks with just reading the title of the thread.

I do hope I am not being over pessimistic, and the NICE ME/CFS evidence review, though the resultant guidelines are not without fault, was to be fair of much higher standard than the related Cochrane reviews.

 

Might be more reasonable if only both NICE and Cochrane had a proper understanding of what constitutes a conflict of interest and subsequently disregarded any reviews that were conducted by those researchers or clinicians who have them, but we know how this goes.

With regards to ME/CFS this piece of news highlights how essential it is that PEM/PESE is considered the cardinal symptom of the condition by NICE.

 

Two organizations utterly incapable of following through on necessary corrections taking several years inspires exactly zero confidence in their ability to do any of this. Neither can even correct basic mistakes made more than a decade ago with overwhelming evidence of failure and massively worsened outcomes.

Zero chance that this is good for patients, it's the kind of news that should send shivers down millions of spines.

 

Why would NICE want to do this??

 

I suspect to cut costs.

A NICE review will be very expensive. And I think if I were the Department of Health I would wonder quite why four years have to be spent creating vast spreadsheets of a body of evidence that turns out to say nothing useful.

Maybe a systematic review is needed but if Cochrane is mostly funded by NIHR the DoH is paying to do the same thing twice.

 

I guess they've agreed some set of protocols about how each uses data, very likely based on what has already been happening without a formal agreement, and this will mean that whenever Cochrane produces a review this can translate into a NICE update without NICE having to go through the full round of its processes. As a management approach it looks to be very sensible, how it works in practice time will tell. I don't think it is particularly sinister although the rule of unintended consequences will no doubt produce some interesting outcomes over time.

 

This is a phenomenally bad idea
https://twitter.com/user/status/1433070622226124807

 

"This is out of control, we rely on Cochrane for this part". NICE is quasi-governmental, subject to some minimal oversight, Cochrane is mostly a private club, has no accountability, will not repeat the mistake of correctly recognizing pseudoscience.

 

Interesting development given that back in April, Cochrane were put on warning by the NIHR (Ken Stein), to become more responsive/efficient or they would take their business elsewhere.

https://www.s4me.info/threads/virtually-cochrane-online-event-20-22-april-2021.19953/#post-343334

 

Why is Cochrane funded by NIHR?

 

Only the review groups (usually based round a disease area) based in the UK are funded by NIHR. That about half of them. Eg. the MS group is based in Italy so is not funded by NIHR. The Work Group is based in The Netherlands. The "consumers and communication" group is based in australia. There is a bloated central executive in London which is funded by NIHR but NIHR are threatening to withdraw the funding for infrastructure. The whole structure is pretty stupid. The way NICE does reviews (ie. reviewing all treatments for one condition at once to inform guidelines) is much more useful to patients. This collaboration with NICE is a way Cochrane can try and survive I guess because they can drip feed reviews on one treatment at a time. But the volunteer model leading to significant problems of researcher allegiance (as we saw with ME CFS reviews) needs to be addressed. I am not confident it will be. But NICE will save money because they won't have to pay professional non-conflicted reviewers any more.

 

So, unprofessional conflicted reviewers are cheaper?

Therefore the way to go.

Gotta love 'em

 

I'm sure they're not *all* unprofessional and conflicted. But there will be no way of telling whether they are or not, and presumably NICE won't be concerned about researcher allegiance any more than Cochrane were with the CFS reviews. Neither Cochrane or NICE look at conflicts in individual studies so I am sure they are not going to start now. I will write and ask how NICE are going to make sure Cochrane reviewers always use GRADE sensibly as they have made different judgements on the evidence quality for GET. There seems little point now in Cochrane continuing with the exercise review as there is no new evidence to feed into NICE's review. So perhaps they will finally withdraw it...

 

Worth every penny!

Wait, is there a smaller currency than a penny because seriously it's not even close to be worth that much in its totality. About worth as much as a weak fart.