Integration of trial, meta-analysis and cohort results with treatment guidelines

IMPORTANCE OF GUIDELINES: Guidelines to medical practice are of vital importance because of the fast and uncontrolled introduction of new technologies, increasing amounts of information, including contradictory results, high levels of inappropriate care and increased financial pressure. Thus guidelines can help solve common problems in all health care systems worldwide. PREPARATION OF GUIDELINES: In preparing guidelines, a synthesis of results from the literature prepared by a single expert must be compared with syntheses done by others, and a consensus recommendation may then be issued. Such a recommendation will not be based exclusively on the results of controlled trials, even when they have indisputable internal validity. There is still a need for a value judgement within a particular psychological and socio-economic context. FREEDOM FOR PHYSICIAN: It is important to preserve the physician's freedom to prescribe drugs or not in conjunction with informed choice by the patient concerning the risks of any long-term drug intervention, even if this freedom of choice does not fit with the expectations of "managed' care or third-party payers.