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Invited Commentary
Nov 26, 2012

In Guidelines We Cannot TrustComment on “Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards”

Arch Intern Med. 2012;172(21):1633-1634. doi:10.1001/2013.jamainternmed.335

The Institute of Medicine (IOM) recently updated its standards for guideline development.1 If adhered to, trustworthy guidelines should follow. Trustworthiness connotes integrity, dependability, and reliability. Unfortunately, in guidelines we cannot trust.

In the late 1990s, 2 colleagues and I critically appraised a broad set of published guidelines and found that guidelines adhered to less than half of the methodological standards for guideline development.2 We opined that since the guideline industry was in its infancy, over time developers would adhere to recommended standards of guideline development. As demonstrated by Kung et al3 in this issue of the Archives, guidelines are still not following guidelines.