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关于“拯救sepsis运动”那些风花雪月的故事（二）

续前...
The ESICM now recognizes that the processes used for the development of the SSC have had many shortcomings, and these have led to the open criticism of the process. It is now important that ESICM be both, perceived as being aware of these past shortcomings and also to be dealing with them so that in the future similar conflicts do not arise. The ESICM has therefore developed a number of strategies and mechanisms to better understand these conflicts so that we can improve our relationships with industrial sponsors without impeaching our ultimate aims, and to minimize undue industrial influence: (实际上这里就代表着ESICM承认了错误，以下为改进措施)

1. The ESICM has an independent Scientific Committee responsible for all the scientific activities and an independent Education Committee to deal with educational issues and publications. It now insists on compulsory disclosure of potential conflicts of interest for all candidates to all posts in the Society, to officers and to invited faculty.

2. The ESICM facilitates the presentation, analysis and debate of over 1,000 original, scientific abstracts annually as a primary feature of its congress and, in the interest of scientific enquiry, encourages openness at these and all meetings and the stimulation of discussion and debate between speakers and the public.

3. In their article, Eichacker and coworkers [3] report that the journal “Critical Care Medicine” removed mention from an invited editorial [8] that the Infectious Diseases Society of America declined to endorse the SSC guidelines. “Intensive Care Medicine”, the ESICM's official journal, has complete editorial and scientific independence, and its publications strongly debated the recommendations of the SSC [9, 10, 11, 12]. 这里开始引用Eichacker的话攻击它的竞争对手《Critical care medicine》了！ 所以我们应该关注《Critical care medicine》下面怎么说了！！！

4. The ESICM now has a formal task force relating to issues of governance. Any internal or external issues causing concern can be referred to this body. The issue of how industrial relationships are handled, both now and in the future, is being addressed by an ongoing association between ESICM, the American Thoracic Society (ATS) and the Society of Critical Care Medicine (SCCM). The aims of this association are to develop and publish clear and transparent guidelines for ongoing relationships with industry and the handling of any conflicts. The ESICM hopes that these issues will allow an open, fair and honest relationship to continue with industry.

Now that these important issues have been raised, there is a need for us to stop and take stock. We need to reassure ourselves of the facts. If mistakes have been made, then they should be understood and corrected. The SSC is currently re-evaluating the guidelines taking into account studies that have been published since the original version. This process commenced in 2005 well before the recent critiques. This is now being done without financial support from industry. Hopefully this will lead to a document that will be accepted by a wider range of clinicians. We also need to ensure that the implementation of these guidelines occurs in a way that cannot be misconstrued as a marketing vehicle for any individual company. We have to accept that if the process of developing guidelines and recommending therapies continues, similar situations are likely to develop. What happens with the next company or their product? We need to develop a process that allows us to champion a therapy alongside the company that makes it, without being criticized for taking a parallel view. If we fail with this important issue, then we may simply end up encouraging companies to spend their valuable research money on other clinical specialties. This may not ultimately be beneficial for critical care. 

We are confident that by openly discussing these issues we can move forward on future projects with our eyes widely open. Rather than decrying our critics, we feel it is important to listen and to learn. We have never doubted the principles of the SSC, or the probity of the leaders of ours and other scientific societies involved in the SSC, since the credibility of scientists and scientific organizations is based on their perceived independence and the reproducibility of any data produced. The ESICM considers it to be extremely important to maintain this credibility, not just of itself as a society but also of each of its members. To this end it will strive to improve its relationships with its industrial partners with the aim of continuing to produce excellent research, education, recommendations and guidelines that improve the care and outcome for our patients.

Acknowledgements  This work was done on behalf of the Council and Executive Committee of ESICM.

References
1. Slade E, Tamber PS, Vincent JL (2003) The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care 7:1–2
2. Dellinger RP, Carlet JM, Masur H et al. (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555
3. Eichacker PQ, Natanson C, Danner RL (2006) Surviving Sepsis: practice guidelines, marketing campaigns, and Eli-Lilly. N Engl J Med 355:1640–1642
4. Wiedermann CJ (2005) Bioethics, the Surving Sepsis Campaign, and the industry. Wien Klin Wochenschr 117:442–444
5. Singer M (2006) The Surviving Sepsis guidelines: evidence-based... or evidence-biased? Crit Care Resuscitation 8:244–245 
6. Weinert CR, Gross CR, Marinelli WA (2003) Impact of randomized trial results on acute lung injury ventilator therapies in teaching hospitals. Am J Respir Crit Care Med 167:1297–1298
7. Brun-Buisson C, Minelli C, Bertolini G et al. (2004) Epidemiology and outcome of acute lung injury in European intensive care units. Results of the ALIVE study. Intensive Care Med 30:4–6
8. Landucci D (2004) The Surviving Sepsis guidelines: “lost in translation”. Crit Care Med 32:1598–600
9. Mackenzie AF (2005) Activated protein C: Do more survive? Intensive Care Med 31:1624–1626
10. Wiedermann CJ (2006) When a single pivotal trial should not be enough: the case of drotrecogin-alfa (activated). Intensive Care Med 32:604
11. Carlet J (2004) A blind clinical evaluation committee should, in theory, make data of a randomized clinical trial stronger, not weaker. Intensive Care Med 30:994
12. Dhainaut JF, Laterre PF, Janes JM, Bernard GR, Artigas A, Bakker J, Riess H, Basson BR, Charpentier J, Utterback BG, Vincent JL (2003) Recombinant Human Activated Protein C Worldwide Evaluation in Sepsis (PROWESS) Study Group. Drotrecogin alfa (activated) in the treatment of severe sepsis patients with multiple-organ dysfunction: data from the PROWESS trial. Intensive Care Med 29:894–903

本来写到这里，还想写点什么，忽然觉得根本没有必要，我们这样的小医生只能雾里看花，即使有着存疑的信念也不知道何地放矢，就笑看潮起潮落，专家们的口沫横飞吧。