The profusion of clinical practice guidelines has been remarked on by many (3;6;8) and ascribed to a need to address the wide geographic differences in practice documented in the last quartercentury (9;10), as well as to the increasing concern with the cost of healthcare. The idea is thatguidelines, by outlining efficient care strategies, will enhance the quality of care and reduceunnecessary or unproductive expenditures. Others hold that guidelines are simply a means oftransferring the results of research from the literature to clinicians (2;5). A darker view ofguidelines sees them as instruments of control of medical practice by uncaring administratorsconcerned solely with cost reduction (4;7).