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Deborah Cook, MD, MSc; Mita Giacomini, PhD

JAMA. 1999;281:1950-1951.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Reports critiquing the validity of randomized trials,¹ meta-analyses,² diagnostic test studies,³ and economic evaluations⁴ have challenged researchers to improve the conduct of their studies and have encouraged readers to interpret them carefully. The study by Shaneyfelt and colleagues⁵ in this issue of THE JOURNAL tackles the clinical practice guideline industry, asking fundamental questions about how well they measure up to contemporary standards. Most guidelines outlined their rationale, specified the benefits and harms of health practices, and cited their evidentiary sources. However, guidelines much less often described how the evidence was found, how its worth was judged, and how diverse sources of evidence were combined to formulate recommendations.

The metric against which clinicians might judge guidelines is complex and multidimensional. Guideline creators, consumers, and critics will recognize the challenge of developing a credible instrument for this purpose. Shaneyfelt et al have captured key features . . . [Full Text of this Article]

Author Affiliations: Departments of Medicine (Dr Cook) and Clinical Epidemiology (Drs Cook and Giacomini) and the Center for Health Economics and Policy Analysis (Dr Giacomini), McMaster University, Hamilton, Ontario. Dr Cook is a consulting editor for JAMA.

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