Sent by:    [log in to unmask]

http://www.miamiherald.com/852/story/99331.html

WHO criticized for neglecting evidence
By MARIA CHENG
AP Medical Writer

LONDON --
When developing "evidence-based" guidelines, the World Health Organization
routinely forgets one key
ingredient: evidence. That is the verdict from a study published in The
Lancet
online Tuesday.

The medical journal's criticism of WHO could shock many in the global
health
community, as one of
WHO's main jobs is to produce guidelines on everything from fighting the
spread of bird flu and
malaria control to enacting anti-tobacco legislation.

"This is a pretty seismic event," Lancet editor Dr. Richard Horton, who was
not involved in the
research for the article. "It undermines the very purpose of WHO."

The study was conducted by Dr. Andrew Oxman and Dr. Atle Fretheim, of the
Norwegian Knowledge Centre
for Health Services, and Dr. John Lavis at McMaster University in Canada.
They
interviewed senior
WHO officials and analyzed various guidelines to determine how they were
produced. What they found
was a distinctly non-transparent process.

"It's difficult to judge how much confidence you can have in WHO guidelines
if
you're not told how
they were developed," Oxman said. "In that case, you're left with blind
trust."

WHO issues about 200 sets of recommendations every year, acting as a public
health arbiter to the
global community by sifting through competing scientific theories and
studies
to put forth the best
policies.

WHO's Director of Research Policy Dr. Tikki Pang said that some of his WHO
colleagues were shocked
by The Lancet's study, but he acknowledged the criticism had merit, and
explained that time
pressures and a lack of both information and money sometimes compromised
WHO
work.

"We know our credibility is at stake," Pang said, "and we are now going to
get
our act together."

WHO officials also noted that, in many cases, evidence simply did not
exist.
Data from developing
countries are patchy at best, and in an outbreak, information changes as
the
crisis unfolds.

To address the problem, they said, WHO is trying to develop new ways to
collect information in poor
regions, and has proposed establishing a committee to oversee the issuance
of
all health guidelines.

The Lancet study - conducted in 2003-04 through analyzing WHO guidelines
and
questioning WHO
officials - also found that the officials themselves were concerned about
the
agency's methods.

One unnamed WHO director was quoted in the study as saying: "I would have
liked to have had more
evidence to base recommendations on." Another said: "We never had the
evidence
base well-documented."

Pang said that, while some guidelines might be suspect and based on just a
few
expert opinions,
others were developed under rigorous study and so were more reliable.

For example, WHO's recent advice on treating bird flu patients was
developed
under tight scrutiny.

Oxman also noted that WHO had its own quality-control process. When its
1999
guidelines for treating
high blood pressure were criticized for, among other things, recommending
expensive drugs over
cheaper options without proven benefit, the agency issued its "guidelines
for
writing guidelines,"
which led to a revision of its advice on hypertension.

"People are well-intended at WHO," Oxman said. "The problem is that good
intentions and plausible
theories aren't sufficient."

It remains to be seen how WHO's 193 member countries will react to The
Lancet
study, released just
before WHO's governing body - the World Health Assembly - meets next week
at
U.N. headquarters in
Geneva to decide future health strategies.

"If countries do not have confidence in the technical competence of WHO,
then
its very existence is
called into question," said Horton, the journal's editor. "This study shows
that there is a systemic
problem within the organization, that it refuses to put science first."

WHO Director-General Dr. Margaret Chan, who took over the position this
year,
will be under pressure
to respond to the study's criticism.

"We need a strong WHO," which in recent years "has seen its independence
eroded and its trust
diminished," Horton said. "Now is a fabulous opportunity for WHO to
reinvent
itself as the technical
agency it was always meant to be."




------------------------------------------------------------------
This mail sent through Netnam-HCMC ISP: http://www.hcmc.netnam.vn/

---
PHA-Exchange is hosted on Kabissa - Space for change in Africa
To post, write to: [log in to unmask]
Website: http://lists.kabissa.org/mailman/listinfo/pha-exchange

-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]

SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.

SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html