What I had always assumed, and what Paduda calls into question, is that guidelines are based on the best science of the day. He puts it as follows:
A recent study may well give you pause - the key finding is rather alarming - many guidelines are NOT based on solid research, but on work that is kindly described as rather more superficial.
Published in the Archives of Internal Medicine, the research found "More than half of the current recommendations of the IDSA (Infectious Diseases Society of America) are based on level III evidence [expert opinion] only." [emphasis added]
Paduda goes on to note that many guidelines are based on good science, but encourages people to be vigilant in asking about the basis of guidelines they come across.
And while that may be good advice for the healthcare professional, or even a well-informed lay person, most patients aren't going to be able to debate the merits of particular guidelines with their doctor, or, more importantly, their insurer.
This bothers me immensely, because care decisions are going to be further centralized in the coming years (probably whether or not Obamacare is repealed, by the way), and the centralizers are going to lean on guidelines to cut costs and standardize care. This seems highly likely to slow the adoption of medical innovation. So never mind that slavish conformity to guidelines limits the opportunities for smart individual physicians to come up with better approaches to care, many of those guidelines may not be worth the glossy medical journal paper they're printed on. Not comforting.