Clinical Practice Guidelines and Scientific Evidence
- John Concato, MD, MS, MPH john.concato@yale.eduVA Clinical Epidemiology Research CenterVA Connecticut Healthcare SystemWest Haven;
- Ralph I. Horwitz, MDStanford University School of MedicinePalo Alto, California
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- ACUTE CORONARY SYNDROMES
- AMERICAN HEART ASSOCIATION
- CARDIOVASCULAR DISEASES
- CLINICAL TRIALS AS TOPIC
- EDUCATION, MEDICAL
- EVIDENCE-BASED MEDICINE
- HOSPITALS
- OUTCOME ASSESSMENT (HEALTH CARE)
- PRACTICE GUIDELINES AS TOPIC
To the Editor: Without commenting on the review of clinical practice guidelines in cardiovascular disease by Dr Tricoci and colleagues,1 we take issue with the corresponding Editorial by Drs Shaneyfelt and Centor2 regarding such guidelines in general. The Editorial endorsed a major assumption—also promoted as a tenet of evidence-based medicine—that data based on the highest level of evidence provide an unequivocal path to improved patient care.
The Editorial considered the substantial proportion of recommendations based on results from nonrandomized studies to represent a failure of the process of developing guidelines. Similarly, the finding that many topics involve conflicting evidence was considered disconcerting. These issues were attributed mainly to the influence of specialty societies and to financial conflicts of interest. Conspicuously absent from the Editorial, however, was any mention of problems with hierarchies of evidence themselves.3,4
The structure of RCTs minimizes bias because of differences in …
