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May 26, 1999

The Trials and Tribulations of Clinical Practice Guidelines

Author Affiliations

Author Affiliations: Departments of Medicine (Dr Cook) and Clinical Epidemiology (Drs Cook and Giacomini) and the Center for Health Economics and Policy Analysis (Dr Giacomini), McMaster University, Hamilton, Ontario. Dr Cook is a consulting editor for JAMA.

JAMA. 1999;281(20):1950-1951. doi:10.1001/jama.281.20.1950

Reports critiquing the validity of randomized trials,1 meta-analyses,2 diagnostic test studies,3 and economic evaluations4 have challenged researchers to improve the conduct of their studies and have encouraged readers to interpret them carefully. The study by Shaneyfelt and colleagues5 in this issue of THE JOURNAL tackles the clinical practice guideline industry, asking fundamental questions about how well they measure up to contemporary standards. Most guidelines outlined their rationale, specified the benefits and harms of health practices, and cited their evidentiary sources. However, guidelines much less often described how the evidence was found, how its worth was judged, and how diverse sources of evidence were combined to formulate recommendations.