Background Guideline development activity is primarily focused in Western Europe and North America. Consequently, western medical interventions and approaches are disproportionately represented among guideline developers. scepticism about cultural variations in treatment, concern of publication bias in specific regions or languages, and resulting scepticism of foreign literature compounds the problem of accurately assessing evidence and making sound recommendations. When accounting for publication bias and/or prevailing cultural paradigms, guideline developers may struggle to determine the benefit-harm ratio of alternative/complementary interventions.
Context A recent guideline development panel struggled with precisely these issues when reviewing available literature to formulate a recommendation on acupuncture therapy for Bell’s palsy patients. All physicians on the panel practiced medicine in the United States, and were unfamiliar with acupuncture therapy. Available literature came predominantly from one country with evidence of severe publication bias. The panel was unable to determine the benefit-harm ratio of acupuncture therapy, and ultimately could make no recommendation for the use of acupuncture for Bell’s palsy patients.
Description of Best Practice Guideline developers need to give careful consideration to interpretation of literature when there may be significant cultural differences in treatment approach, cultural bias among the panel, or publication bias that may affect recommendations. Transparent discussion that recognises these issues will help ensure that recommendations regarding alternative/complementary interventions are sound.
Lesson for Guideline Developers Guideline developers need to be aware of potential bias as to how cultural differences in treatments are represented in guideline recommendations, and be mindful regarding the cross-cultural applicability of guideline content.
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