Evidence-Based Medicine and the American Thoracic Society Guidelines

To the Editor In a recently published Research Letter, Schumacher and colleagues¹ argue that clinical guideline committees that make recommendations with only low-quality evidence do not promote the practice of evidence-based medicine. We feel that the authors misconstrued the role of clinical guidelines. According to the prevailing standards by the Institute of Medicine,² committees should synthesize and rate the quality of evidence and then make recommendations using both the evidence and expert consensus. Individual frontline clinicians must then interpret the guidelines in the context of their individual patients. Guidelines are intended for the aggregate and cannot address every clinical nuance and exception.