The best medicine? Experts propose a program to help decide.

Imagine for a moment that you're a dedicated doctor confronting a thorny problem in a patient with high blood pressure who previously suffered a stroke. Unsure what medication to prescribe, you turn to the National Guideline Clearinghouse (http://www.guidelines.gov), a US government–sponsored website that compiles clinical practice guidelines intended to help doctors like you. There, you find no fewer than 471 different guidelines related to high blood pressure and another 276 that are relevant to stroke.

“We have a proliferation of clinical practice guidelines being written by any number of organizations all over the map,” explains Merrill Goozner, director of the Integrity in Science project at the Center for Science in the Public Interest in Washington, DC. “Which ones are right?”

Enter the Institute of Medicine (IOM), an independent scientific advisory body established by the US government. In late January, the institute issued a report, titled “Knowing What Works in Health Care: A Roadmap for the Nation,” that recommended US lawmakers establish and fund a new national program to set quality standards for clinical guidelines, which today rely on different forms of medical evidence and analysis. The ultimate aim is for doctors, insurers, patients and anyone else trying to sort wheat from chaff to use only clinical recommendations that meet these standards.

“We need some mechanism of pulling the information together in a way that will provide a roadmap to physicians, and perhaps to patients,” says Barbara McNeil, who heads the department of health care policy at Harvard Medical School in Boston. The new program, acting on advice from a committee of external advisers, would identify the most urgent questions about the treatment of specific medical conditions, and then assess existing evidence concerning the efficacy of these treatments. The aim is to clarify “what has passed muster and is considered to clearly provide a health benefit, what hasn't, and what is in a grey zone,” adds McNeil, who chaired the 16-member committee that wrote the IOM report.

McNeil and the committee envision a staffed organization—either within the government or a public-private partnership—that could respond readily to pressing questions, such as “Are artificial discs effective for people with crumbling backbones?” (Recently, the health insurance giant Aetna determined such discs are “medically necessary” in some cases, whereas Medicare called them “not reasonable and necessary.”)

Critics, however, say that the project is misguided. “The danger is that the attempt to set rigorous national clinical practice guidelines through prolonged analysis and review— even with the best of intentions—will slow the advance of new medical technologies and deny patients timely access to new therapeutic options,” says Paul Howard, a health care analyst at the Center for Medical Progress, a branch of the conservative Manhattan Institute for Policy Research in New York.

Howard points to a 2005 study by Sweden's Karolinska Institute, titled “A pan-European comparison regarding patient access to cancer drugs.” The study found that reviews by the UK's National Institute for Health and Clinical Excellence (NICE)—which appraises treatments for the country's universal healthcare system—delayed UK cancer patients' access to new therapies compared to those in the US, France and Switzerland.

In the meantime, with the US Congress preoccupied with presidential elections, a teetering economy and a major ongoing war, it may be a while before lawmakers weigh in on whether the IOM's recommendations are the right prescription for change.