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Comment & Response
July 2019

Evidence-Based Medicine and the American Thoracic Society Guidelines—Reply

Author Affiliations
  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
  • 2Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
JAMA Intern Med. 2019;179(7):1004-1005. doi:10.1001/jamainternmed.2019.1656

In Reply We are encouraged by the commitment of Myers and Bates and Dweik and colleagues, members of the American Thoracic Society’s (ATS) guideline community, to develop robust clinical practice guidelines (CPGs).

A common theme expressed in both responses to our study1 stems from a philosophical difference on the role of CPGs. Given that CPGs often set the standard of care, we, and others,2 argue that CPGs should not routinely make strong recommendations based on little-to-no scientific evidence. Such recommendations are at greater risk for medical reversals3 and may do more harm than good. The ATS has embraced this philosophy before. When confronted with low-quality evidence, the 2014 CPG regarding the diagnosis of intensive care unit–acquired weakness did not make any clinical practice recommendations but did include a narrative synthesis of the available evidence.4 This approach provides insight for clinicians without defining a standard of care. We applaud the ATS for this restraint and believe this should be closer to the norm rather than issuing many strong but weakly supported recommendations.

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