Concerns About Consensus Guidelines for QTc Interval Screening in Methadone Treatment
Authors: Gavin Bart
Journal: Annals of Internal Medicine (2009)

Letters4 August 2009Concerns About Consensus Guidelines for QTc Interval Screening in Methadone TreatmentFREEGavin Bart, MDGavin Bart, MDFrom Hennepin County Medical Center, Minneapolis, MN 55415.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-3-200908040-00016 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The clinical guidelines by Krantz and colleagues (1) raise important methodological concerns. Although Krantz and colleagues use a method for predicting adverse drug reactions, they neglect to use data extraction and quality assessment tools. In fact, they state that they “did not prespecify critical appraisal criteria.” This is contrary to Annals' “Information for Authors” (2), which requires guidelines to include a grading system, such as those described by the Conference on Guideline Standardization; the Grading of Recommendations Assessment, Development and Evaluation Working Group; or the U.S. Preventive Services Task Force (USPSTF).On review of the 212 articles listed in Annals' online “Clinical Guidelines/Position Papers” collection (accessed 9 February 2009), I found 94 unique clinical guidelines. Excluding 2 updates on adult vaccination schedules, 54 of the remaining 92 guidelines used a grading system, whereas 28 guidelines systematically rated the quality of evidence supporting guideline recommendations. Eight of the 10 guidelines providing neither grade nor quality assessment were published before 1998, when such quality assessments became routine. Therefore, the guidelines by Krantz and colleagues are 1 of 2 guidelines published by Annals since 1998 that do not explicitly evaluate or grade the quality of evidence used in guideline recommendations. Using USPSTF criteria (3), the literature cited by Krantz and colleagues would result in a grade of I, indicating that the evidence is insufficient to determine the relationship between the benefits and harms of QTc screening. Had the authors expounded on this and incorporated recent methods (published in Annals) (4) for guidelines based on insufficient evidence, the reader would be better equipped to make rational clinical decisions.Of further interest, although Krantz and colleagues summarize their recommendations in Table 2 under the title “Consensus Recommendations,” 2 of the panelists have declined acknowledgment in the publication, which raises the question: Was there consensus?In addition, the online version (but not the print version) of this article states that 3 of the panel members have financial conflicts of interest related to support by Reckitt Benckiser (1 was formerly President and CEO), the producer of methadone's main competitor (buprenorphine) in the treatment of opiate dependence. These disclosures were not made in the original, withdrawn version of the guidelines.These issues call into question the quality of Krantz and colleagues' recommendations, the independence of the authors, and the judgment of Annals in publishing clinical guidelines that fall well outside the normative standards.Gavin Bart, MDHennepin County Medical CenterMinneapolis, MN 55415References1. Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann Intern Med. 2009;150:387-95. [PMID: 19153406] LinkGoogle Scholar2. Information for Authors. Ann Intern Med. Accessed at www.annals.org/shared/author_info.html#guidelines-and-position-papers on 10 June 2009. Google Scholar3. Barton MB, Miller T, Wolff T, Petitti D, LeFevre M, Sawaya G, et al; U. S. Preventive Services Task Force. How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force. Ann Intern Med. 2007;147:123-7. [PMID: 17576997] LinkGoogle Scholar4. Petitti DB, Teutsch SM, Barton MB, Sawaya GF, Ockene JK, DeWitt T; U. S. Preventive Services Task Force. Update on the methods of the U.S. Preventive Services Task Force: insufficient evidence. Ann Intern Med. 2009;150:199-205. [PMID: 19189910] LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Hennepin County Medical Center, Minneapolis, MN 55415.Disclosures: Dr. Bart received a National Institutes of Health–National Institute on Drug Abuse Career Development Award to study the pharmacokinetics and pharmacogenetics of methadone. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHow to Read the New Recommendation Statement: Methods Update from the U.S. Preventive Services Task Force Mary B. Barton , Therese Miller , Tracy Wolff , Diana Petitti , Michael LeFevre , George Sawaya , Barbara Yawn , Janelle Guirguis-Blake , Ned Calonge , Russell Harris , and Update on the Methods of the U.S. Preventive Services Task Force: Insufficient Evidence Diana B. Petitti , Steven M. Teutsch , Mary B. Barton , George F. Sawaya , Judith K. Ockene , Thomas DeWitt , and QTc Interval Screening in Methadone Treatment Mori J. Krantz , Judith Martin , Barry Stimmel , Davendra Mehta , and Mark C.P. Haigney Concerns About Consensus Guidelines for QTc Interval Screening in Methadone Treatment Mori J. Krantz , Judith Martin , Barry Stimmel , and Mark C.P. Haigney Concerns About Consensus Guidelines for QTc Interval Screening in Methadone Treatment Andrew Byrne Concerns About Consensus Guidelines for QTc Interval Screening in Methadone Treatment Steven P. Cohen and Jianren Mao Concerns About Consensus Guidelines for QTc Interval Screening in Methadone Treatment George Girgis Metrics Cited ByMethadone Therapy in Underserved Urban Community: QTc Prolongation and Life-Threatening Ventricular ArrhythmiasUse of Methadone in Opioid Maintenance Treatment 4 August 2009Volume 151, Issue 3Page: 218KeywordsConflicts of interestDrug abuseFallsHealth care quality assessmentInformation technologyOpiatesPharmacogeneticsPharmacokineticsTreatment guidelines ePublished: 4 August 2009 Issue Published: 4 August 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...