Perspectives on industry and the sepsis guidelines

A commentary on this ongoing controversy, Is Industry Guiding the Sepsis Guidelines? A Perspective, appeared in a recent issue of Critical Care Medicine. (I’ve had a thing or two to say about it here, here and here).

Author Charles Durbin, M.D. notes the unacceptably high mortality in sepsis, the potential for multiple evidence based modalities to impact this mortality and the universal gap between publication of evidence and clinical implementation. The Surviving Sepsis Campaign (SSC) was conceived to try and close this gap. The task, unfortunately, took extensive resources, resources not available from public funding. Although Eli Lilly supported the logistics of the campaign the company had no role in the development of the guidelines.

The Society of Critical Care Medicine (SCCM) undertook the process of sepsis guideline revision last year without industry sponsorship in order to avoid unwarranted criticism. Durbin hints that the revised guidelines and bundles will not substantially change, thus supporting the work of the 2004 authors.

He concludes:

Viewed pragmatically, the SSC under the stewardship of respected medical societies is a fundamentally sound and promising endeavor to improve patient care. The premises of the Campaign remain vital: 1) the mortality rate for severe sepsis is unacceptably high; 2) practice guidelines, developed through a rigorous evidence-based review of the literature, must be translated into practice; and 3) research questions about the efficacy of a bundle approach in severe sepsis and the differential impact of combining sepsis therapies must be answered. SCCM strongly supports the call for the creation of public funding mechanisms to accomplish translational research. In the meantime, the Campaign will press forward to reduce mortality attributable to severe sepsis with the resources available.

The more vocal guideline critics seem mainly to be screaming about the role of industry, offering little in the way of constructive criticism. One wonders whether they’re concerned with anything more than industry bashing. If they want to help doctors take better care of patients with sepsis they should discuss the evidence on its own merits. If the guidelines are hopelessly flawed they should help develop better ones. Everyone will get along better and patients will benefit.