Rebuttal: Should primary care guidelines be written by family physicians? NO.

Guidelines should be of high quality and guidelines without specialists will miss their required expertise. I think we all agree that guidelines should be of high quality. However, previous guidelines have sadly not met the standards laid out by Dr Bourbeau.1 Transparency: For 69% of Canadian guidelines, no information is provided on conflicts of interest.2 Conflicts of interest: Up to two-thirds of guideline contributors have conflicts of interest.3 Group composition: Specialists outnumber all other health care providers combined2 (even though they provide ≤ 22% of the care4). Evidence foundation: About 50% of guideline recommendations are based on nothing more than expert opinion.5,6 Clearly, we have long way to go. Further, my recommendation is not to exclude specialists from primary care guidelines. Rather, as Dr Bourbeau suggested, we must attain an appropriately balanced group composition.