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J R Soc Med. 2004 February; 97(2): 97.
PMCID: PMC1079307

Legal considerations of clinical guidelines

I agree with Dr Walden1 and Dr Doney2 that guidelines can be dangerous as they can have a spurious authority. In time all guidelines will be shown to be partly or wholly wrong. They may even be politically engineered. The 1999 publication Drug Misuse and Dependence—Guidelines on Clinical Management3 is an example. It contains serious errors of fact and ignores good evidence that conflicts with its 'consensus' views. These guidelines are published by the Department of Health as '... clinical interventions for drug misuse and dependence are subject to a number of regulations for the prescribing of controlled drugs...' (p. xiv). If that were so then guidelines on palliative care would also be written by the Department of Health. It is clear that these guidelines are subject to political scrutiny and if unacceptable to the Department of Health they would not be published.

The guidelines then state (p.xv) '... any doctor not fulfilling the standards and quality of care in the appropriate treatment of drug users that are set out in these Clinical Guidelines, will have this taken into account if, for any reason consideration of their performance in this clinical area is undertaken...'. The guidelines then say '... in that these Guidelines do represent a consensus view of good clinical practice, it is expected they will be a significant reference point in assisting the General Medical Council [GMC] in its power to examine reports of poor performance by medical practitioners...'.

These guidelines are concealed government regulation that in this context is an act of deception. Also, the GMC must have been involved in discussions about these guidelines before their publication, thus gravely impairing the GMC's impartiality. Beware of guidelines!


1. Walden RJ. Legal considerations of clinical guidelines. J R Soc Med 2003;96: 412-13 [PMC free article] [PubMed]
2. Doney IE. Legal considerations of clinical guidelines. J R Soc Med 2003;96: 573 [PMC free article] [PubMed]
3. Department of Health. Drug Misuse and Dependence—Guidelines on Clinical Management. London: Stationery Office, 1999

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