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WHO's Guidelines Lack Evidence, Lancet Says

mation in poor regions, and has proposed establishing a committee to oversee the issuance of all health guidelines. The Lancet study conducted in 2003-04 through analyzing WHO guidelines and questioning WHO officials also found that the officials themselves were concerned about the agencys methods.

One unnamed WHO director was quoted in the study as saying: I would have liked to have had more evidence to base recommendations on. Another said: We never had the evidence base well-documented.

Pang said that, while some guidelines might be suspect and based on just a few expert opinions, others were developed under rigorous study and so were more reliable. For example, WHOs recent advice on treating bird flu patients was developed under tight scrutiny.

Oxman also noted that WHO had its own quality-control process.

When its 1999 guidelines for treating high blood pressure were criticized for, among other things, recommending expensive drugs over cheaper options without proven benefit, the agency issued its guidelines for writing guidelines, which led to a revision of its advice on hypertension.

People are well-intended at WHO, Oxman said. The problem is that good intentions and plausible theories arent sufficient.

It remains to be seen how WHOs 193 member countries will react to The Lancet study, released just before WHOs governing body the World Health Assembly meets next week at U.N. headquarters in Geneva to decide future health strategies.

If countries do not have confidence in the technical competence of WHO, then its very existence is called into question, said Horton, the journals editor. This study shows that there is a systemic problem within the organization, that it refuses to put science first.

WHO Director-General Dr. Margaret Chan, who took over the position this year, will be under pressure to respond to the studys criticism.


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