Following public scrutiny, the American Heart Association recently withdrew statements that alteplase for strokes saves lives. The association rated the thrombolytic agent as a class I (definitely recommended) intervention for stroke despite controversy about its safety and efficiency. Most of the association's stroke experts have ties to the manufacturer of this drug and Genentech, the US manufacturer of alteplase, contributed over $11m (£7.8m; €12.6m) to the association in the decade before this recommendation. Lenzer (p 723) cautions that seemingly impartial organisations that issue professional guidelines may have ties to the manufacturers of recommended interventions. In a commentary, Warlow (p 726) expresses fears that more is going to be added to the bureaucratic sludge by insisting that guideline writers and any sponsoring organisations declare just how much they have received from whom to do what as this information should be available on websites. In another commentary Saver and colleagues (p 727) insist that thrombolytic treatment in strokes works and that the real scandal is that it is not used often or wisely enough.
