An Australian hypertension expert has weighed in on a debate raging among cardiologists over the authorship of recently published US hypertension guidelines, arguing that a doctor’s worth shouldn’t be measured on their research profile alone.
The clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians on The Pharmacological Treatment of Hypertension in Adults Aged 60 Years or Older has come under fire because many cardiologists believe its authors don’t have the expertise or research profile required to pen major guidelines.
Writing in Hypertension this week some 30 cardiologists have put their names to an editorial slating the two societies for appointing the ‘unqualified’ group.
But in a commentary responding to the editorial renowned hypertension expert Professor John Chalmers, senior director of the Professorial Unit at The George Institute in Sydney has thrown his support behind the guideline committee, urging doctors not to relegate expertise to the ‘realms of research.’
“There is another world, inhabited by clinicians and practitioners both in primary care and in hospital practice, and often working alongside us,” the highly acclaimed hypertension researcher and past president of the Australian Society of Medical Research wrote.
“This world too has many very erudite practitioners, often those we like to have care for close friends or members of our family when they are ill, and they too can have very considerable expertise in the same disorders that we like to write about.”
He also pointed out that the medical profession continues to be laden with pressures to reduce the influence of conflicts of interest, especially when it comes to relationships with guideline committee members and pharmaceutical companies.
That kind of pressure has pushed major organisations responsible for guidelines to avoid many experts – including ‘well-reputed clinical trialists with significant pharma support’, from membership of guideline committees he noted.
He added that ‘rigid adherence’ to conflict of interest policies to the point of excluding qualified experts can pose problems but he argued that ‘expertise’ would need to be redefined.
“I am not in a position to judge the merits of the authors of the ACP/AAFP guidelines in [their clinical and professional capacity], but it is possible that some at least would qualify for the term expert in the field of hypertension.
Others could qualify for the term expert through their experience and expertise in the process of guideline development, or in areas such as assessment of research proposals from an ethical perspective,” he noted.
However, he did acknowledge that the absence of research-based experts from the guideline committee was ‘a pity’.
The group of concerned cardiologists includes Dr Franz Messerli, Director of the hypertension Program at St. Luke’s-Roosevelt Hospital Center in New York and a founding member of the American Society of Hypertension.
With more than 800 published research papers to his name, he is regularly referred to as a leading authority on the condition.
The cardiologists listed several concerns about the guidelines including its inability to answer the vital question – what is the optimal blood pressure treatment target in hypertensive patients aged ≥60 years?
They also criticised the guidelines for failing to identify angioedema as a rare but potentially fatal adverse event of ACE-inhibitors and for not considering the results of SPRINT (Systolic Blood Pressure Intervention Trial) in its recommendations.
“If there were selection criteria for the authors of these hypertension guidelines, they must have been other than special skills or knowledge acquired by a person through education, training, or experience,” the group writes.
Citing a PubMed search, the cardiologists also claimed that three of the seven ACP/AAFP guideline committee have never authored an article on hypertension while one has co-authored a single study.
What’s more, they argued that not one of the guideline authors is known to be a hypertension specialist certified by the American Society of Hypertension or a member of the society or other relevant societies.
It also took aim at the fact that none of the guideline authors is currently serving on the editorial board of a journal dealing with hypertension.
“The complete absence of individuals with experience in hypertensive cardiovascular disease makes the ACP/AAFP Guidelines unacceptable to practicing physicians,” they wrote.