title: Is the Guideline Process Replicable and, if Not, What Does This Mean?
abstract: Increasingly, guidelines determine how medical care will be provided. However there has been limited study of the determinants of the reliability of the guideline process. Guidelines translate evidence into recommendations. If only the evidence determines the recommendations, given the same evidence, different panels of experts should make the same recommendations. That is, the process should be replicable, an essential characteristic of a valid scientific process. The multiple recent cholesterol guidelines, which have considered the same evidence, offer an opportunity to examine guidelines from this perspective. Considerable discordance among the guideline recommendations is evident pointing to an important role for the participants, in addition to the evidence, in the development of guideline recommendations. Guideline recommendations, therefore, appear to be based on both evidence and expert opinion.
authors.affiliation: Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: allansniderman@hotmail.com.
authors.forename: Allan
authors.initials: A
authors.lastname: Sniderman
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Curt D
authors.initials: CD
authors.lastname: Furberg
authors.affiliation: CH Medical Center, Sterling, Illinois and Ciccarone Center for Cardiovascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: Preventive and Genomic Cardiology, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D032921:Consensus; D019317:Evidence-Based Medicine / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011314:Preventive Health Services / Q000379:methods / Q000592:standards*; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D015415:Biomarkers; D002784:Cholesterol
keywords: Cardiovascular prevention; Cardiovascular risk; Evidence-based medicine; Guidelines; LDL-C