Author: Antonio Cunha
Position: Professor and Dean
Institution: School of Medicine, Federal University of Rio de Janeiro
E-mail: acunha@ufrj.br
Submitted Date: June 08, 2007
Published Date: June 8, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

I would like to congratulate Schünemann et al for this very interesting and useful article (1). In fact, proposing a systematic and transparent approach to develop guidelines may be useful not only for health problems that require rapid advice, but for any health problem, not necessarily emerging including the existing ones in a certain setting. For instance, the proposed approach may be very useful to assess health technologies, new ones or old ones not yet assessed, in many low income countries.

Taking Brazil as an example, teams could be created in state and/or municipality level health secretariats to use this approach whenever a decision is needed regarding the purchase of drugs, products or technologies or their inclusion on clinical guidelines. Local Universities could collaborate in this process by suggesting names of expert faculties to join the panels and this would also increase credibility. In addition, health economists could take part in the process to advice on cost-effectiveness issues to support the decisions taken. For this strategy to succeed health authorities should coordinate the process and other stakeholders should be involved, such as for instance representatives of civil society patient associations.

In some specific circumstances, like the one presented in the article (uncertainty about the pharmacological management of avian influenza A H5N1 virus infection), the time frame to conclude the process is crucial. This might not be the case for several other circumstances, such as for example the decision to purchase aspirin or paracetamol to distribute in health centers freely (what occurs in Brazil) to treat children’s common diseases with fever. The possibility to use the approach not so rapidly makes it even more useful. An evaluation of the guidelines developed will still be necessary, to ensure their usefulness and this could be conducted by the same team, this time coordinated by the University faculties already participating in the process.

Reference

1. Holger J. Schünemann, Suzanne R. Hill, Meetali Kakad, Gunn E. Vist, Richard Bellamy, Lauren Stockman, Torbjørn Fosen Wisløff, Chris Del Mar, Frederick Hayden, Timothy M. Uyeki, Jeremy Farrar, Yazdan Yazdanpanah, Howard Zucker, John Beigel, Tawee Chotpitayasunondh, Tran Tinh Hien, Bülent Özbay, Norio Sugaya, Andrew D. Oxman. PLoS Medicine Vol. 4, No. 5, May 2007