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J R Soc Med. 2007 July; 100(7): 325.
PMCID: PMC1905872

Bufale Spotting, part 4: Assessing a guideline


Beware of guidelines prepared by single scientific societies or groups. Bin guidelines with no methods chapter or conflict of interest statement, or those not drafted by a multidisciplinary group.


AGREE (Appraisal of Guidelines Research and Evaluation) is a complex but bufala-unfriendly instrument ( It is made up of six specific domains reflecting key aspects of a guideline, including:

  • Scope and purpose;
  • Stakeholder involvement;
  • Rigour of development;
  • Clarity and presentation;
  • Applicability to real-world situations;
  • Independence of the editorial group that developed the guideline.


Guidelines are a flourishing industry. Everyone writes them, but few will withstand the rigours of the quick instrument and even fewer of AGREE. Clinical guidelines are supposed to apply to real world situations, so the idea that they can be written by members of a single discipline is ridiculous. Bear in mind that even the best guideline has a heavy qualitative component and manipulations are still possible.


This is the fourth in a series of articles on making evidence-based medicine work for you. The series is based on the book ‘Attenti Alle Bufale’ by Tom Jefferson (


1. Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet 2000; 355: 103-6 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press