Guidelines can harm patients too

The clinical entity of guideline fatigue syndrome has already been described in the BMJ: “a debilitating condition characterised by irritability and overwhelming lethargy in the presence of guidelines.”1 My own chronic guideline fatigue syndrome underwent an acute exacerbation recently, with the arrival of another set of guidelines in my email inbox. On reviewing the level of evidence provided for the various recommendations being offered, I was struck by the fact that no relevant clinical trials had been carried out in the population of interest. Eleven out of 25 of the recommendations made were supported only by the lowest levels of published evidence (case reports and case series, or inference from studies not directly applicable to the relevant population). A further seven out of 25 were derived only from the expert opinion of members of the guidelines committee, in the absence of any guidance to be gleaned from the published literature.

Quite deliberately, I’m not naming the particular set of …