When would medical guidelines (eg NICE) be intentionally not followed when prescribing, for the patients good

Question

Eg. BTS chronic asthma steps not strictly adhered to, NICE guidelines not followed etc, and the justification for such action.

Answer 1

Medical practitioners have always had the option to prescribe a drug off-label. That is not for the purpose approved by the FDA. Many drugs have multiple uses and side effects. An example of a drug prescribed for its side effect is Erythromycin prescribed to diabetics who suffer from gastroparesis. This would be considered off label. It works very well and has been used for such treatment for more than 50 years. The medical community has changed and now use of off-label medications now carries such a greater risk of malpractice and other headaches for the practitioner that many doctors are afraid to continue a priveldge they have held for a long time. Guidelines are just that, guidelines. In many circumstances, especially because the physician knows the patient well, is aware of allergic reactions, susceptibilities to side effects, compliance, etc., he or she may chose to prescribe or treat the patient differently because the treatment will be more effective.