Guidelines for clinical practice are intended to indicate pre-ferred approaches to medical problems as established by sci-entifically valid research. Double-blind, placebo-controlled studies are preferable, but compassionate use reports and ex-pert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physi-cians who address the subject without regard to specialty train-ing or interests and are intended to indicate the preferable, but not necessarily the only, acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of specifics in any health care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the Ameri-can College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. Each has been intensely reviewed and revised by the Committee, other experts in the field, physicians who will use them, and spe-cialists in the science of decision analysis. The recommenda-tions of each guideline are therefore considered valid at the time of their production based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity.
Frank L. Lanza (Sun,) studied this question.