Healthy Skepticism Library item: 15141

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Shaneyfelt TM, Centor RM.
Reassessment of Clinical Practice Guidelines: Go Gently Into That Good Night
JAMA 2009 Feb 25; 301:(8):868-9
http://jama.ama-assn.org/cgi/content/extract/301/8/868

Abstract:

In 1990, the Institute of Medicine proposed guideline development to reduce inappropriate health care variation by assisting patient and practitioner decisions.1 Unfortunately, too many current guidelines have become marketing and opinion-based pieces, delivering directive rather than assistive statements.

Current use of the term guideline has strayed far from the original intent of the Institute of Medicine. Most current articles called “guidelines” are actually expert consensus reports. It is not surprising, then, that the article by Tricoci et al2 in this issue of JAMA demonstrates that revisions of the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines have shifted to more class II recommendations (conflicting evidence and/or divergence of opinion about the usefulness/efficacy of a procedure or treatment) and that 48% of the time, these recommendations are based on the lowest level of evidence (level C: expert opinion, case studies, or . . .