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To the Editor: We strongly disagree with the Editorial by Drs Shaneyfelt and Centor¹ that impugned the clinical practice guidelines process and urged clinicians to reject calls for adherence to guidelines. As past chairs of the ACC/AHA Task Force on Practice Guidelines, we believe that their concerns have already been answered by the current ACC/AHA clinical practice guideline process.²

First, although an average of 50% of recommendations in ACC/AHA guidelines are based on evidence level C (expert consensus), the conclusion by Shaneyfelt and Centor that all of these recommendations reflect subjective bias was not justified. Many recommendations are based on sound clinical judgment that will never be tested in a clinical trial (eg, obtaining a 12-lead electrocardiogram in a patient presenting to the emergency department with chest pain). As part of the deliberate ACC/AHA guidelines review process, the work of the writing committee is typically critiqued by an additional 35 . . . [Full Text of this Article]

Elliott M. Antman, MD
eantman@rics.bwh.harvard.edu
Brigham and Women's Hospital
Boston, Massachusetts

Raymond J. Gibbons, MD
Mayo Clinic
Rochester, Minnesota

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