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.
Concato J, Horwitz RI. Clinical Practice Guidelines and Scientific Evidence. JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.914