huangwei98，想不想家？

V. M. Ranieri is a paid member of the advisory board of Maquet and received research grants from Tyco, Draeger and Hamilton. From February 2005 to June 2006 he consulted for Eli-Lilly in the creation of the “AboutSepsis.com” website. He is a member of the SSC guidelines group. He is the president of ESICM.

R. P. Moreno received a traveling sponsorship and honoraria from Eli-Lilly to chair an industry-organized session in 2003. He is the president-elect of ESICM.

A. Rhodes consults and performs research for Edwards Lifesciences and consults for Abbott Laboratories. He is a member of a DSMB for Orion Pharma and is a member of the SSC guidelines writing committee. He is the chair of the Division of Scientific Affairs for ESICM.

 

好了，我们还是把他们的全文刊登出来，如果这该死的BLOG又因为字数限制，我就连载：

Sir: During the annual congress of the European Society of Intensive Care Medicine (ESICM) in Barcelona (September 2002), several hundred participants signed a declaration giving birth to the Surviving Sepsis Campaign (SSC) [1]. This declaration called on health care professionals and their organizations, governments, health agencies and public to support an initiative to reduce the mortality from sepsis by 25% within 5 years. This process involved a number of leading international societies coming together to develop an evidenced-based set of guidelines [2] for the management of severe sepsis that could then be implemented into clinical practice with beneficial effects for patient outcome. In recent months, however, this process has been strongly criticized by a number of authors [3, 4, 5]. These criticisms include the following issues:

1. The sponsors of the SSC were too closely aligned with the process.

2. This closeness allows the integrity of the guidelines to be questioned.

3. The implementation process of the guidelines has become part of a marketing strategy for one of the sponsors.

Although ESICM is not synonymous with the SSC, it is one of the founding societies of the campaign and by association is therefore criticized in these papers.

The integration of recent research findings into routine clinical practice is often slow, and this delay is part of the reason why patient outcomes do not always improve as quickly as the underlying data suggest they should [6, 7]. The production of evidence-based guidelines that aim to change current clinical practice to improve patient outcomes should therefore be actively encouraged as they can help accelerate this process. The SSC is therefore an example whereby research data are incorporated into a set of guidelines with the aim of producing recommendations that accelerate the change in clinical practice to a new and theoretically superior standard of care. All of the recommendations included in the SSC guidelines reflect an evidence-based appraisal of available data. Unfortunately the processes involved with the SSC have become entangled in a web of controversy despite the good will, best intentions and integrity of the leading experts involved in the development of the SSC guidelines.

The major issue that has been raised surrounds the need for industrial money to support the process. The fact that the SSC had a single sponsor that provided almost 80% of the financial support certainly amplified the consequences of such limitations and potentially led to the perception that biased behavior may have affected the process. It must be remembered that although there is the general perception that industry and one company in particular funded the guidelines, the relative contributions of the involved societies has never been either quantified or taken into account. When we consider the number of society officers and members that have worked on this process without reimbursement, we can begin to recognize that the relative contributions from industry are not perhaps as significant as we may be led to believe.

At the onset of this process ESICM recognized the limits that industrial support of this type of process change project may bring. The utilization of sponsors to support the process was not considered ideal; however, other streams of funding were not readily available and it was felt that careful handling of the situation would enable a clear and transparent method for supporting the process. The debate within ESICM bodies came to the conclusion that appropriate distancing between the sponsors and the guidelines writing committees would ensure that direct influence was kept to the minimum. These firewalls were instituted so that there were no industrial representatives present in either the original guideline development meeting in Windsor, U.K., or the revision meeting held in San Francisco in 2006. These firewalls should allow us to be confident that the SSC guidelines document is the considered recommendations from a number of esteemed scientific experts and remains scientifically valid. It should be stressed that the guidelines deserve to be judged only on their scientific merit, which will inevitably change following appropriate open debate and the appreciation and understanding of new data that becomes available. Whether or not inappropriate industrial influence occurred within the SSC process is difficult to discern; however, it is plain to see that, in general, the interests of the marketing departments are in direct conflict with independent clinician's views.

The relationships between scientific societies and industry are complex and fraught with problems. Although inextricably linked, each society has very different strategies, behaviors, interests and end points. In theory, each group exists to improve the care of patients; however, in practice this is not always the prime motivation for any decision-making process. The primary objective of industry is to sell their products and make money for their owners or shareholders. Societies such as our own should impartially represent their members and should therefore provide advice and support that is in the best interests of patient care irrespective of the implications of that advice for outside parties. There is, therefore, and always has been, a potential for a direct conflict of interest between these groups. These conflicts can take the form of many different guises and can often be difficult to detect. Although economic conflicts can be disclosed and managed, academic issues are less easy to handle. If we take the example of the “New England Journal of Medicine” article about the SSC [3], authors that did not directly contribute to the recent multi-centre randomized clinical trials on sepsis, despite their leading position at the National Institutes of Health, one of the most relevant institutions supporting and producing clinical research worldwide, may have had quite obvious academic interests in publishing their points of view. These conflicts have been neither declared nor discussed.

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看来还是要连载了！