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Invited Commentary
December 2014

Prevention Guidelines: Bad Process, Bad Outcome

Author Affiliations
  • 1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Intern Med. 2014;174(12):1972-1973. doi:10.1001/jamainternmed.2014.3278

Thomas Jefferson, the third American President and author of the Declaration of Independence, famously opined, “Governments derive their just powers from the consent of the governed.” The principle underlying this simple statement is an essential component of any collection of rules that govern how individuals conform to behavioral standards. Clinical practice guidelines should explicitly or implicitly follow the same principles. Guidelines are effective only when they involve the participation and consent of the stakeholders whose behavior they intend to govern. The 2011 Institute of Medicine (IOM) report1 in 2011 (Clinical Practice Guidelines We Can Trust) emphasizes transparency and public involvement as integral to the development process. In this context, the recently issued guidelines for cholesterol reduction2 represent an important failure of guideline governance and oversight process. Rather than forging a consensus on cholesterol management, the guidelines have further polarized the debate on appropriate use of statin medications.

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