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In two critical evaluations, investigators have assessed the reliability of clinical practice guidelines.
The first study concerned guidelines issued by the Endocrine Society, which uses the GRADE system (each recommendation is rated as strong or weak, and the quality of evidence supporting each recommendation is rated as high, moderate, low, or very low). Among 357 recommendations in 17 guidelines issued between 2005 and 2011, 121 (34%) combined a strong recommendation with low-quality evidence. Such guidelines require scrutiny because they strongly advocate a particular practice despite relatively weak supporting evidence. Using an explicit process, the authors found 33 instances in which no compelling justification for a strong-recommenda…