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January 28, 2009

Why Guideline-Making Requires Reform

Author Affiliations

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).

JAMA. 2009;301(4):429-431. doi:10.1001/jama.2009.15

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.