Guidelines should not include opinions

The authors of this viewpoint have it wrong on a couple of fronts.

“The purpose of practice guidelines must be to develop the best possible recommendations from a body of evidence that may be contradictory or inadequate.”

While I agree that having recommendations come from an expert body is useful when there is inadequate or contradictory evidence I don’t think they should be labeled guidelines. A consensus statement is a more appropriate term. After all, if evidence is lacking or contradictory aren’t these experts just giving their opinion? Isn’t it possible that another group of experts would give a different opinion?

So don’t label it a guideline. That term has garnered reverence that was never intended. Guidelines become law almost. They are bastardized into punishing performance measures and become the cornerstone of legal argument. So, the term guideline should not be used lightly.

“…but those recommendations should always represent the best evidence and the best expert opinion currently available.”

NO! No expert opinion. Data is too open to interpretation. Humans filter information using prior knowledge, experience, and many heuristics (including, very importantly, the affect heuristic). A person’s specialty really influences how they interpret data. It’s one of the reasons it’s so important to have multidisciplinary panels so that conflicts and heuristics can be balanced. Unfortunately, most guideline panels are very homogeneous and conflicted.

I agree that we need unambiguous language in guidelines. They should only contain recommendations on things that have strong evidence that no one refutes. When they venture into the world of vagaries they become nothing more than opinion pieces.

What say you?

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