A statement (below) by the Cochrane Collaboration notes that WHO has substantially improved its processes for guideline development, but says there is still room for improvement. In particular, it points to the need for research on ‘how to create guidelines for urgent public health problems where evidence may be very scarce or of poor quality’.
As a personal comment, this latter point is clearly the responsibility of the entire health research (and publishing and information sciences) community, and not of WHO specifically. If one is to look specifically at how better to appraise and synthesise evidence that may be scarce of of poor quality, perhaps the first priority is to ensure that all relevant research is indeed identified, so as to avoid the possibility that guidelines fail to include existing research.
Looking more broadly, a holistic approach is needed that not only makes the best use of ‘scarce or poor quality’ research, but also addresses the many underlying *causes* of the scarcity of high quality research – to move progressively towards a global research agenda that aligns with global health priorities.
(This statement is all about the quality of WHO guidelines. The elephant in the room is, of course, not the quality of WHO guidelines but the gap between WHO guidelines and actual policy and practice.)
I look forward to hear from HIFA members on these important issues.
Cochrane issues statement on WHO guidelines development and governance
Cochrane is an international organization that produces high-quality, relevant, accessible systematic reviews and other synthesized research evidence, and promotes evidence-based decision-making. Cochrane has been an NGO in official relations with the World Health Organization (WHO) since 2011 and an important part of our workplan involves support for the WHO guideline development process.
Cochrane contributors published some of the earliest critiques of the WHO guideline process (Oxman, 2007) which called for guidelines to use reliable, independent research summaries that are free of conflicts of interest (Boyd, 2006). WHO responded to these criticisms by developing a uniform review process in developing guidelines. This included implementing procedures to manage conflicts of interest. Recent analyses of WHO guidelines (Sinclair, 2013; Burda, 2014) have shown that editorial independence and use of reliable evidence have increased markedly since WHO has implemented these reforms, and highlight that these high standards are essential for WHO’s credibility.
WHO guideline panels have implemented procedures to make the link between recommendations and the underlying evidence more transparent. There is room for improvement (Alexander, 2013). Further research is needed to improve methods to create guidelines for urgent public health problems where evidence may be very scarce or of poor quality. Cochrane will continue to offer methodological support and training to WHO as it tackles these challenges.
Cochrane urges WHO to continue strengthening the use of evidence following a rigorous methodology in guideline development. We recognize that panels should be cognizant of public and member state commentary on the issues, but the guidelines process needs to remain independent and separate from any individual or body with potential conflicts of interest. Involving participants with conflicts of interest in guideline development is likely to influence recommendations, make them less evidence based and impact on their credibility (Cosgrove, 2013). Cochrane urges the WHO to protect against the influence of conflicts of interest in the guideline development process to ensure that the identification and evaluation of the best available evidence remains at its core.
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