74.5% of Obstetrican Recommendations are not Science or Evidence based.
Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins
Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD; Lewin, Sharyn N. MD; Burke, William M. MD; Simpson, Lynn L. MD; Charles, Abigail S. MS; D'Alton, Mary E. MD; Herzog, Thomas J. MD
OBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College).
METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations.
RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.3%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049).
CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.
LEVEL OF EVIDENCE: III
In case you didn't catch it, for only obstetric recommendations, Level A (25.5%) is based on good and consistent evidence, Level B (39.7%) is based on limited or inconsistent evidence, and Level C (34.8%) is based on consensus and opinion. This means that 74.5% of all obstetric recommendations in this study were made based on something other than science or evidence-based medicine. Only 25.5% of obstetric recommendations were science and evidence based.
Better make sure you do your homework :)
It will be interesting to see what affect this study has. I really wish I could read the whole thing, but a subscription costs $400 bucks!