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Letters Evidence in guidelines

Some forms of knowledge are more equal than others

BMJ 2012; 345 doi: (Published 06 November 2012) Cite this as: BMJ 2012;345:e7429
  1. Santhanam Sundar, consultant oncologist1
  1. 1Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
  1. sundar{at}

Zuiderent-Jerak and colleagues make a pertinent point that all knowledge, whether derived from randomised trials or clinical experience, should be reflected in guidelines.1 But that does not mean that “the hierarchy of evidence” need be discarded.

To paraphrase George Orwell, …

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