This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Medical Education  • Cardiovascular System  • Quality of Care  • Evidence-Based Medicine  • Quality of Care, Other  • Statistics and Research Methods  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: We recognize that many excellent guidelines exist. We object to calling recommendations guidelines unless they meet rigorous standards. Expert opinions are important but should be labeled expert opinions rather than guidelines. The presence of fewer guidelines might actually have a greater effect on health care than the current explosion of guidelines. If guideline committees wrote 2 parallel reports—one presenting guidelines and another identifying issues that need more data and for which only expert opinion can be given—then practicing physicians would better understand those issues that deserve guidelines.

Drs Antman and Gibbons point out that many expert recommendations made in guidelines are based on sound clinical judgment and will never be tested in a clinical trial. However, what is considered sound clinical judgment changes over time. Not long ago experts recommended against using β-blockers in patients with heart failure and recommended suppressing premature ventricular contractions after myocardial infarction.^1-2 Expert . . . [Full Text of this Article]

Terrence M. Shaneyfelt, MD, MPH
terry.shaneyfelt@va.gov

Robert M. Centor, MD
Department of Veterans Affairs
Birmingham, Alabama

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Clinical Practice Guidelines and Scientific Evidence
Susan L. Norris
JAMA. 2009;302(2):142.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Finlay A. McAlister
JAMA. 2009;302(2):142-143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Francesco Enia
JAMA. 2009;302(2):143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Christian M. Pettker and Edmund F. Funai
JAMA. 2009;302(2):143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Elliott M. Antman and Raymond J. Gibbons
JAMA. 2009;302(2):143-144.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Mark D. Huffman and Robert O. Bonow
JAMA. 2009;302(2):144-145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
John Concato and Ralph I. Horwitz
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Robert S. Bobrow
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Shyam S. Kothari
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence—Reply
Pierluigi Tricoci, Robert M. Califf, and Sidney C. Smith, Jr
JAMA. 2009;302(2):145-146.
EXTRACT | FULL TEXT