Medical guidelines designed to avoid damage to the heart during non-cardiac surgery in Europe recommend the use of beta-blockers. But the guidance was partially written by and largely based on work by the recently disgraced dutch researcher Don Poldermans.
Forbes sums up the story:
Current European Society of Cardiology guidelines recommend that beta-blockers be given to many patients having surgery for noncardiac reasons to protect the heart during surgery. (US guidelines are somewhat less aggressive in their endorsement of perioperative beta-blockade.) The guidelines, which were published in 2009, were based on analyses of the available trials. The strongest evidence came from the DECREASE family of trials, which appeared to strongly support perioperative beta-blockade, and one other large trial, POISE, which raised concerns that beta-blockers might lead to an increase in deaths. When the ESC committee combined all the data they found a neutral effect on mortality but a strong benefit due to significant reductions in non-fatal MI and stroke with beta blocker use. This was the basis for the strong recommendation in the ESC guidelines.
In 2011, however, faith in the reliability of the DECREASE trials was shattered as a result of a scientific misconduct scandal centering on the principal investigator of the studies, the now disgraced Dutch researcher Don Poldermans. The issue was further complicated because, in addition to his key role in the trials, Poldermans was the chairman of the committee that drafted the guidelines.
A reanalysis of the known results when Poldermans' work is excluded showed that the standard recommended practice of using beta-blockers would significantly increase deaths. Forbes summarises their initial results:
Each year in the UK, according to the Heart authors, 2.5 million procedures are performed each year for which this treatment is recommended in the current guidelines. Based on a 27% increase in the risk of death associated with perioperative beta-blockade, they calculated that as many as 10,000 deaths might be caused by physicians faithfully following the guidelines.
But their work is not entirely uncontroversial and an extension of their estimate to Europe as a whole has been withdrawn by a journal (see the follow up story in Forbes).
Have clinical guidelines based on this faulty research killed tens of thousands of people undergoing surgery?