Published: Tuesday, 18 Aug 2009 | 11:32 AM ET

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It sounds like a simple idea for improving health care: draw up guidelines on how best to treat a particular illness and then pay doctors to follow them. That strategy, which some insurers and health plans already employ, has been embraced during the health care debate by some lawmakers in Congress who want to extend it more broadly.

The goal is to improve treatment and, at the same time, save money. But setting guidelines that are good for every patient, it turns out, can get messy, with some experts warning that a big national plan of this sort poses risks. A recent case involving treatment for diabetes, one of the nation’s most pervasive illnesses, illustrates the difficulties.

Last year, a national guideline-setting group abruptly withdrew a controversial diabetes standard it adopted in 2006 that called for aggressive control of blood sugar, or glucose. The change came after a large federal study indicated that lowering glucose too quickly or too much in some patients could harm or even kill them.

In medical journal articles and elsewhere over the last year, some diabetes experts have lashed out at the group’s initial decision to approve the guideline, saying they warned back in 2006 that it was medically ill-advised for some patients.

“This was a case in which the advocates of a disease got caught up in their disease rather than the interests of patients,” said Dr. Rodney A. Hayward, a diabetes expert at the University of Michigan who had opposed the benchmark.

Critics like Dr. Hayward have also suggested that pharmaceutical companies influenced the guideline so they could sell more glucose-lowering drugs like insulin. The group that set the guideline, a Washington organization called the National Committee for Quality Assurance, received about $3 million, or 10 percent of its revenue, last year from drug and medical device makers.

The group’s officials, and several outside experts who advise it, rejected such suggestions of industry influence. Still, some experts question why the group, which sets standards that are widely used by insurers and private health plans, should take even small amounts of drug-industry money.

“There should not be any industry funding of a group that is involved in working on national guidelines,” said Dr. Jerome E. Groopman, a professor of medicine at Harvard.

To many experts, the diabetes case shows how setting one guideline that works for all patients suffering from the same disease can be tricky.

The main problem is that many guidelines are based not on rigorous studies like clinical trials but on weaker types of medical evidence. And critics like Dr. Groopman have argued that the guideline-setting process is often influenced by industry or by medical ideologues looking to advance their personal agendas.

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