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- Page navigation anchor for RE: Don’t freeze specialists out of guideline development: Akin to airline safety standards that ignore pilots and engineersRE: Don’t freeze specialists out of guideline development: Akin to airline safety standards that ignore pilots and engineers
This March 18, 2019 Commentary article by Ismail Jatoi and Sunita Sah in the Canadian Medical Association Journal levels serious accusations against specialist physicians’ professionalism, integrity and commitment to care, which the Canadian Psychiatric Association (CPA) believes are unfounded and demand a response.
The authors suggest that “independent […] organizations that have few or no vested interests in the medical services at stake” are better placed to develop guidelines given that ones formulated by specialists are troubled by specialty bias, fee-for-service conflicts of interest or both, and specialists’ interests may not always align with the public’s interests.
Organizations such as the Canadian Task Force on Preventive Health Care (CTFPHC) are funded by governments, which, as payors, have a clear interest in controlling budgets and reducing costs. Physicians are bound by codes of ethics that do not apply to politicians and functionaries. The simplistic conclusion that specialist physicians recommend more interventions and care because they make more money doing so is shockingly unscientific, denigrating, and ignores the fact that specialists have been trained and are qualified to make certain clinical decisions.
Psychiatrists are specialist physicians with extensive medical training in the causes, diagnosis, treatment and ongoing care of mental disorders in patients of all ages. Their medical training and expertise in psychological dev...
Show MoreCompeting Interests: The CPA President, Dr. Wei-Yi Song was a member of the Canadian Network for Mood and Anxiety Treatments (CAMAT) Depression Work Group which developed CANMAT’s 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. - Page navigation anchor for RE: Clinical practice guidelinesRE: Clinical practice guidelines
Dear Editors – On behalf of the membership of the NCCN guidelines panel on the Early Detection of Prostate Cancer, we disagree with the assertions of Drs. Jatoi and Sah that the NCCN guidelines drive the overuse of health care services and conflict with evidence-based recommendations of other independent organizations.
Without specific evidence, Drs. Jatoi and Sah argue that, through its advocacy of population-based prostate-specific antigen (PSA) screening for early detection of prostate cancer in selected, well – informed men, the NCCN guidelines serve the financial interests of providers rather than patients. They extol the recommendations of “independent” multidisciplinary panels, including the United States Preventive Services Task Force (USPSTF)( USPST, Grossman DC, Curry SJ, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901-1913.) and assert that, unlike these panels, the NCCN promotes recommendations biased in favor of specialists.
However, they fail to note that the USPSTF currently recommends consideration of PSA screening as part of shared decision making for men aged 55 to 69 years. This inconsistency in their argument is troubling. Moreover, they cite two outdated recommendations against PSA screening—the Canadian Task Force on Preventive Care of 2014 and the European Society of Medical Oncology Consensus Panel of 2012 (Annals of Oncology 24: 1141–1162, 2013)—that do not in...
Show MoreCompeting Interests: Members of the NCCN Panel on the Early Detection of Prostate Cancer - Page navigation anchor for RE: Routine ColonoscopyRE: Routine Colonoscopy
With no family history of colon cancer I began routine colonoscopy screening in 1988 on a three year schedule. Routine polypectomy, with no adverse pathology occurred with no bleeding involved. In January 2016 a pathological examination of a non-bleeding polyp revealed a cancerous lesion confined to the mucosal lining. Subsequent colectomy of the ascending colon confirmed the diagnosis and recovery has excellent with no additional treatments or therapy. I am grateful for the early diagnosis in the absence of internal colonic bleeding and the advice of my gastroenterologist to do surgery immediately.
Competing Interests: None declared.