RT Journal
A1 Antman EM, Gibbons RJ
T1 CLinical practice guidelines and scientific evidence
JF JAMA
JO JAMA
YR 2009
FD July 8
VO 302
IS 2
SP 142
OP 147
DO 10.1001/jama.2009.912
UL http://dx.doi.org/10.1001/jama.2009.912
AB 
First, although an average of 50% of recommendations in ACC/AHA guidelines are based on evidence level C (expert consensus), the conclusion by Shaneyfelt and Centor that all of these recommendations reflect subjective bias was not justified. Many recommendations are based on sound clinical judgment that will never be tested in a clinical trial (eg, obtaining a 12-lead electrocardiogram in a patient presenting to the emergency department with chest pain). As part of the deliberate ACC/AHA guidelines review process, the work of the writing committee is typically critiqued by an additional 35 to 50 physician leaders.2 Thus, the final recommendations reflect the input from extensive peer review and are not simply the opinion of the writing committee members.2- 3