Co-authored by John Brock-Utne, MD, PhD
It is common practice these days to invite industry sponsors to support education meetings. When these meetings are put on by the CSA and ASA, special care is taken to ensure that attendees are aware of any potential conflicts of interest and product promotions. As such the speaker should always declare any conflict of interest prior to the lecture starts. At any such lecture or meeting, it is important that attendees be sensitive to the interpretations of endorsements.
A speaker at an industry-sponsored medical meeting may make recommendations regarding the equipment they highlight and possibly promote. They may even imply that this equipment, might allow anesthesiologists to meet requirements of a standard, guideline, advisory or statement of a professional society through its use.
On the ASA website you can find the following definitions:
Standards provide rules or minimum requirements for clinical practice. They are regarded as generally accepted principles of patient management. Standards may be modified only under unusual circumstances, e.g., extreme emergencies or unavailability of equipment.
Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert opinion, open forum commentary, and clinical feasibility data.
(A Practice Advisory is similar to a Guideline but relies more on consensus of expert opinion, where published research evidence is lacking. Similar rigorous methodology applies in the development of both).
Statements represent the opinions, beliefs, and best medical judgments of the House of Delegates. As such, they are not necessarily subjected to the same level of formal scientific review as ASA Standards or Guidelines. Each ASA member, institution or practice should decide individually whether to implement some, none, or all of the principles in ASA statements based on the sound medical judgment of anesthesiologists participating in that institution or practice.
Hence when you are attending industry-sponsored lectures it is important that you are aware of these definitions. Otherwise you may think that the equipment promoted is recommended by the ASA and not using it makes you out of compliance of the professional society. Just to be clear the CSA and ASA do not support or endorse any particular brand name device or drug as a means of adhering to standards. Similarly, it is important not to confuse standards with guidelines, advisories or statements. A practice guideline, advisory, or statement is not mandatory for clinical practice and may be adapted as appropriate to local or clinical conditions. Only standards “provide rules or minimum requirements for clinical practice. They are regarded as generally accepted principles of patient management. Standards may be modified only under unusual circumstances, e.g., extreme emergencies or unavailability of equipment.” Therefore it is important that you are aware that a suggested practice guideline, advisory, or statement is not represented as a standard.
The ASA Standards, Guidelines, Advisories and Statements are there to provide guidance to improve your decision-making in your anesthesia practice. They may be found on the ASA website at http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx.
In conclusion, make sure that you understand that a practice guideline or advisory is not misrepresented as or construed as a standard or statement.