Conflicts behind guidelines have been an open scandal for decades, but universities mostly avoid leadership to deal with the issues.  No wonder so many guidelines are short-lived, as real evidence emerges that renders them ludicrous in retrospect.  What mechanism exists to hold guideline developers responsible if their recommendations lead to worsened health or diversion of public (& private) resources from genuinely useful investments - clean water, safe housing, improved diet, and physical fitness.  Ask yourself why many communities lack public swimming pools or fitness centres, yet pointless or overly expensive drugs are ubiquitous? 

In my one experience of a "guideline" process I witnessed the highly conflicted chief drover  bully colleagues into obviously unscientific "conclusions" and recommendations.  It was frightening to observe the subservience of less powerful colleagues.

What's Jane Philpott's excuse for doing nothing?  Do "sunny ways" preclude action?

Tom Perry MD