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AMB Guidelines Program
Rev Assoc Med B ras 2017; 63(5):387 387
EDITORIAL
AMB Guidelines Program
Programa D iretrizes da AMB
Wanderley Marques Bernardo 1*, Florentino Cardoso1
1Associação Médica Brasileira (AMB)
*Correspondence:
It has been 17 years of struggle, during which many have
participated. Naming these individuals is not necessary,
for they all continue to fight for the rights of patients,
and their names are not hidden, they are public who take
responsibility for what they think and write.
The struggle has been to keep the program running
funded with AMB’s own resources, without the support
of those who, exercising an eminently political function,
insist that there is a conflict of interest in the AMB guide-
lines. They are understandably unable to admit their own
economic and political conflicts, and to critically appraise
the fundamental elements of evidence-based guidelines.
The Guidelines Program is the space we have used to
convey recommendations whose sole purpose is to increase
benefits and reduce harm to patients. These recommen-
dations express the thoughts of experts and are written
primarily based on the best available evidence. Speaking
on the basis of the best available evidence implies know-
ing how to obtain it, criticize it, synthesize it and translate
it, considering the experience and expectations of both
doctors and patients.
Many specialists are involved in the development of
thousands of recommendations, distributed in more than
700 guidelines, which receive methodological guidance
from a technical team of the AMB itself, with experience
in systematic review and the language of guidelines.
The whole process begins with the elaboration of rel-
evant clinical doubts by specialists (in Brazil, our program
was the first to develop guidelines based on questions).
These doubts are structured in a PICO (Patient, Interven-
tion or Indicator, Comparison and Outcome) format,
seeking to facilitate the organization of questions and the
construction of search strategies. Searches are performed
minimally on Medline, and usually on more bases. The
selection of references is based on previously established
eligibility criteria (the main ones being PICO and design),
and this entire process is clearly displayed in the guideline’s
methodology section. After selection of evidence, data
regarding the characteristics of the studies, their biases
and outcomes of clinical interest are extracted. The
strength of evidence is estimated using grading systems
such as Oxford and GRADE. With such information in
hand, the authors are able to develop the recommendations
by estimating their level of uncertainty, and the magnitude
and precision of benefit and/or damage effects.
The specialists frommedical specialty societies that are
part of AMB are not mere validators of a previously prepared
text, but authors who, together with AMB’s technical team,
develop all stages of elaboration. After the guidelines are
finalized, all AMB specialty societies that did not participate
in the elaboration of that particular document are consult-
ed so that they have the opportunity to contribute.
In Brazil, unfortunately, apart from the AMB Guide-
lines Program, “they” are always producing “booklets” with
methodology for developing guidelines (true Portuguese
versions of international manuals). Despite all the resourc-
es they have, very little has been done. Moreover, what has
been done lacks a level of attention to evidence, medical
experience and, worse, attention to the patient’s needs,
operating through two health systems (private or govern-
ment-funded) divided into two guidelines that are NOT
based in evidence: 1. Guidelines without limits, in which
everything is accepted, and 2. Guidelines with strict limits,
according to which almost nothing can be accomplished.
The AMB Guidelines Program, regardless of what
“they” say, is reputable, very reputable, transparent, very
transparent, exempt, has method, and contradicts many
interests, including “theirs”. But it never contradicts the
interests of patients and, with all of its limitations result-
ing from these individuals’ constant boycott and omission,
it endures thanks to the willingness, dedication and self-
lessness of thousands of medical specialists. We are always
open to all criticism and suggestions from those who have
the interest and/or ability to do so.
References
1. Bernardo WM. Cheers!!! Rev Assoc Med Bras (1992). 2016;62(9):809-810.
2. Bernardo WM, Carneiro AV, Baracat EC. [Guidelines: unity and balance].
Rev Assoc Med Bras (1992). 2009;55(5):498-9.
3. Bernardo WM. [Clinical guidelines in Brazilian health system]. Rev Assoc
Med Bras (1992). 2008;54:377.