1.i. Caveats to Recommendation
In applying these guidelines
recommendations, the reader should note some caveats:
- The emphasis of these
guidelines was to identify effective interventions, not to rank-order
interventions in terms of relative efficacy or effectiveness. The panel chose
not to emphasize comparisons among interventions, because there were few
studies that compared long-term outcomes, and, since patient preference often
dictates choice of therapy, we wished to present a menu of options rather than
a ranked list of choices.
- When no evidence was
available on the efficacy of various treatments, the panel usually rendered no
opinion. An absence of studies should not be confused with an absence of
effect. While clinicians may wish to use proven therapies in preference to
untested therapies, the lack of testing does not prove that the untested
therapy does not work.
- The limitations of RCTs
must be kept in mind. The RCT is the primary method for demonstrating efficacy.
Often, patients enrolled in RCTs differ from the patients in a primary care
practice, and effectiveness in the community may differ from efficacy as
measured in an RCT. The potential exists for misinterpretation of clinical
trial results. Analysis of endpoints not specified at the outset, post hoc, or
subgroup analyses should be viewed as hypothesis-generating rather than