Not all guidelines are created equal

[The editor responds:]

I commend the CHEP for its efforts to reduce bias resulting from financial competing interests when developing guidelines. The steps outlined in their letter lead in the right direction. In our editorial1 we did not claim, as stated by Campbell and McAlister, that „guideline panels should consist only of non-experts.” Clinical expertise (especially if financially unencumbered) is important, especially in choosing meaningful clinical questions for randomized trials and in selecting endpoints for efficacy and adverse events. Analysis of the resulting data and summations of that data across multiple clinical trials (meta-analyses, evidence reviews of all sorts and guideline recommendations) are much more dependent on methodological expertise. Indeed, recommendations of clinical experts and of guidelines supported by sponsors with commercial interests are heavily biased toward those interests.2