Why Guideline-Making Requires Reform
- Allan D. Sniderman, MD;
- Curt D. Furberg, MD
- Author Affiliations: Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, McGill University, Montreal, Canada (Dr Sniderman); and Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Furberg).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- CONFLICT OF INTEREST
- ETHICS, MEDICAL
- EVIDENCE-BASED MEDICINE
- GUIDELINES AS TOPIC
- QUALITY OF HEALTH CARE
Guidelines are a constructive response to the reality that the practicing physician requires assistance to assimilate and apply the exponentially expanding, often contradictory, body of medical knowledge. Guidelines are widely perceived as evidence based, not authority based, and therefore as unbiased and valid. Because they are sponsored by organizations, staffed by experts, and conducted according to apparently formal processes, the products of the exercise—the guidelines—are generally assumed to have the same level of certainty and security as conclusions generated by the conventional scientific method. For many clinicians, guidelines have become the final arbiters of care.
Guidelines have taken hold and multiplied. The National Guideline Clearinghouse has registered 2373 guidelines produced by 285 organizations.1 Indeed, any group of individuals can designate itself a guideline group and different guideline groups have reviewed the same disease and reached different conclusions.2,3 If the process is so secure, how is this …
