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Is an evidence-based approach to creating guidelines always the right one?

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 60–61 (2008)Cite this article

Few, at first glance, would argue against the use of evidence-based medicine (EBM) as the basis for guideline development, and this approach has become de rigeur in the developed world. In many parts of the world, however, medicine is practiced in a context that is far removed—in terms of resources, patterns of disease and cultural attitudes to health—from the environment in which guidelines in North America and Europe are developed. A global guideline developed on the basis of the latest and best evidence will, quite simply, be irrelevant in the developing world.1 Can global guidelines be constructed on the basis of anything else but evidence? What if the evidence is very weak?

An evidence-based approach to guideline development begins with a definition of key questions such as who are the patients involved, what are the alternative management strategies under consideration, what are the clinical outcomes of interest and what is the methodological quality of the available evidence? For a guideline to be fully evidence-based, a systematic review of the evidence pertaining to the question must be available.2 The evidence-based approach specifies a hierarchy of evidence ranging from randomized, controlled, clinical trials to well-conducted observational studies focusing on patient-important outcomes to inferences from basic research and nonsystematic clinical experience or expert opinion.

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Authors and Affiliations

  1. Michael Fried is Director of the Division of Gastroenterology and Hepatology at the University Hospital Zürich, Zürich Switzerland,

    M Fried

  2. Eamonn MM Quigley is President of the World Gastroenterology Organisation and Professor of Medicine and Human Physiology at the University College Cork, Cork, Ireland,

    EMM Quigley

  3. Richard H Hunt is Professor of Medicine and Gastroenterology at McMaster University Health Science Centre, Hamilton, ON, Canada,

    RH Hunt

  4. Gordon Guyatt is a Professor in the Department of Clinical Epidemiology and Biostatistics and the Department of Medicine at McMaster University, Hamilton, ON, Canada,

    G Guyatt

  5. Benjamin O Anderson is Professor of Surgery at the University of Washington, Joint Member at the Fred Hutchinson Cancer Research Center in Seattle, WA, USA, and Chair and Director of the Breast Health Global Initiative,

    BO Anderson

  6. David J Bjorkman is Dean of the University of Utah School of Medicine, Salt Lake City, UT, USA,

    DJ Bjorkman

  7. Michael JG Farthing is the Vice Chancellor of the University of Sussex, Brighton, UK,

    MJG Farthing

  8. Suleiman S Fedail is Chairman of Fedail Medical Center, Khartoum, Sudan,

    SS Fedail

  9. Ronald Green-Thompson is a Professor in the Kwa-Zulu Natal Department of Health, Durban, South Africa,

    R Green-Thompson

  10. John Hampton is Emeritus Professor of Cardiology at the Queens Medical Centre, University Hospital of Nottingham, Nottingham, UK,

    J Hampton

  11. Justus Krabshuis, Director of Highland Data, Tourtoirac, France,

    J Krabshuis

  12. Loren Laine, Professor of Medicine at the University of Southern California School of Medicine, Los Angeles, CA, USA,

    L Laine

  13. Richard Horton is Editor-In-Chief of The Lancet, London, UK,

    R Horton

Authors
  1. M Fried
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  2. EMM Quigley
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  3. RH Hunt
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  4. G Guyatt
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  8. SS Fedail
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  9. R Green-Thompson
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  10. J Hampton
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  11. J Krabshuis
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  12. L Laine
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  13. R Horton
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Corresponding author

Correspondence to M Fried.

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The authors declare no competing financial interests.

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Fried, M., Quigley, E., Hunt, R. et al. Is an evidence-based approach to creating guidelines always the right one?. Nat Rev Gastroenterol Hepatol 5, 60–61 (2008). https://doi.org/10.1038/ncpgasthep0997

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