“Squidgy” Guidelines: What are they and what can we do about them?

November 18, 2016


Ever tried to catch a jellyfish? Or squeeze a squid in your hand? Or wrestle with an octopus?  You can’t deny that these squishy, and malleable invertebrates share one important characteristic:  They have no spine.

While being pliable and elastic might be important qualities for sea-dwelling creatures, they are terrible qualities in clinical practice guidelines. The unpleasent truth is that expert opinion, conflicts of interest and other forces make many of our contemporary guidelines just that, squidgy and unreliable.

This fact is behind the fun and engaging #ShowMoreSpine Campaign, launched in Barcelona at the 4th annual Preventing Overdiagnosis Conference. This team of researchers, writers and animators are experimenting with colourful, multimedia ways to tackle one major aspect of overdiagnosis:  the problems with “Squidgy” guidelines and unfounded of disease definitions that threaten to turn more and more people into patients.  This can result in inappropriate labels, overdiagnosis and harmed patients. 

It’s no accident that a campaign that focuses on bone diseases has as its mascot, Squidgy, who can be easily squeezed and cajoled — a mischievous jellyfish who clearly mocks us with his spinelessness.


Dr. Teppo Järvinen

“This is just a fun way to get people to think about the basic problem of many guidelines,” says the group’s leader, Orthopedic surgeon Dr. Teppo Järvinen from the University of Helsinki.

In the world of osteoporosis, an area in which he is one of the world’s leading experts, Teppo says the squidginess of guidelines are absurd.

“Is it not totally bizarre that 75% of osteoporosis guidelines do not establish a standard cut-off point –a criteria–when diagnosing vertebral fractures?” he asks, adding that “ depending on the criteria used to define a change in x-ray as a fracture, 3 in a hundred or 90 in a hundred have it.” This is clearly a problem for Teppo because “the majority of the existing osteoporosis treatment guidelines state that all vertebral fractures warrant osteoporosis medication.”

While the possibility of overdiagnosing and overtreating osteoporosis is huge and affect millions of women around the world, it might be unrecognized by many practitioners.  The result? Many people are medicalized and medicated for no good reason.

The #ShowMoreSpine team is tackling this problem academically, but also trying to highlight it with amusing animations, video interviews with experts in the field to inspire everyone to show a bit more backbone.

“My suggestion is both simple and difficult,” says Teppo. “We all need to stand up to squidgy guidelines in whatever area we’re working in. If squidginess of guidelines and overwide disease definitions are threatening patients, we need to do something about it!”

While this is the start of the #ShowMoreSpine campaign, you’re sure to see more of them as they prepare for Quebec city next year (August 17-19, 2017) which is hosting the next Preventing Overdiagnosis conference.

Check out showmorespine.com and meet the variety of sea creatures inhabiting the shady world of guidelines.  Take a look at videos and photos, and sign up to receive the newsletter. Above all ask yourself:  “What can I do to show more spine?”

Author – Alan Cassels

2 comments on ““Squidgy” Guidelines: What are they and what can we do about them?

  1. Pingback: “Squidgy” Guidelines: What are they and what can we do about them?

  2. Pingback: Guías “Squidgy” (inconsistentes): ¿Qué son y qué podemos hacer con ellos? | Clinica Razonable

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