gms | German Medical Science

Most producers of clinical guidelines have recognised the importance, when developing guidelines, of reviewing systematically what can be known from existing research evidence. In addition, some guideline producers have contributed to the identification of important evidence gaps and the promotion of research to fill them. Guideline producers are thus in an influential position to ensure that, first and foremost, clinical research evidence serves the interests of patients and the public. I will present for discussion two of the many ways in which guideline producers can hold the clinical research community to account, and increase the likelihood that guidelines will impact positively of the health of patients and the public. First, biased under-reporting of clinical research compromises the validity of the work of clinical guideline producers. As a result of clinical trial registration we now know that the scale of this reporting bias is massive, and that it continues to result in substantial preventable suffering and death. Guideline producers must join the calls for an end to this unethical, unscientific and uneconomical practice. Second, there are mismatches between the questions and outcomes studied by researchers, which tend to reflect commercial and academic interests, and the questions and outcomes deemed important by patients, carers and clinicians. If research evidence is to inform decisions in clinical and public health practice, these mismatches will need to be identified and addressed, and clinical guideline producers are in a strong position to demand the changes that are needed.