Practice guidelines are an important innovation in patient care. According to the 2011 Institute of Medicine (IOM) definition, practice guidelines are “statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.”1 In the United States, guideline programs began in the early 1980s. As guidelines have been used for decisions about insurance coverage and standards for measuring quality of care, they have become increasingly influential, and conflict of interest (COI) in developing guidelines has become an important concern.