Many guideline failures are not failures of evidence alone, they are failures of process. Economic constraints, logistical complexity, and political realities exert a profound influence on guideline development, yet these forces are rarely discussed in the methodology literature despite being obvious to anyone who has lived through a guideline development process. The previous posts …
In 2025, a systematic review assessed the methodological rigour of 76 clinical practice guidelines published by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) between 2013 and 2024. These are not obscure documents from minor societies. They are among the most cited, most influential guidelines in medicine, …
In 1951, the United States Air Force had a question that could not be answered by experiment: how many atomic bombs would be required to significantly disrupt U.S. industrial capacity under nuclear attack? There were no historical precedents to draw on, no experiments to run, no datasets to analyse. All the Air Force had …
In 1990, while serving as director of the internal medicine residency program at McMaster University in Hamilton, Ontario, Gordon Guyatt introduced a new approach to teaching at the bedside. He called it “Scientific Medicine.” The idea was straightforward: clinical decisions should be grounded in a critical appraisal of the best available evidence, not in …
This is the first in a five-part series on the science and methodology behind clinical practice guidelines and consensus statements. The series “From Hippocrates to Delphi” is named for the arc that connects the earliest attempts to codify medical practice to the structured consensus methods we use today. Hippocrates gave us the idea that clinical …