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 quarter century (9;10), as well as to the increasing concern with the cost of health care. The idea is that guidelines, by outlining efficient care strategies, will enhance the quality of care and reduce unnecessary or unproductive expenditures. Others hold that guidelines are simply a means of transferring the results of research from the literature to clinicians (2;5). A darker view of guidelines sees them as instruments of control of medical practice by uncaring administrators concerned solely with cost reduction (4;7).