Attacks on guidelines raise several common criticisms. Critics may question the legitimacy of the guideline committee. When a primary care group, such as the USPSTF, issues a guideline, subspecialists often label the recommendations unsound because the panel did not include subspecialty experts. This criticism can be vicious when recommendations call for more parsimonious use of interventions from which subspecialists profit—consider radiologists’ discontent with the USPSTF mammography recommendations (10). Conversely, when subspecialists issue guidelines, generalists sometimes gripe about the lack of primary care perspective. When guidelines focus on trials, critics call for recommendations to consider observational data and clinical experience. The presence of conflicts of interest is another common source of controversy, with claims that recommendations are designed to fill the pockets of those who would profit from the interventions advocated. Finally, guidelines that recommend against a course of action are often condemned for rationing care. The general public and many clinicians believe that, by default, more health care is better health care. Thus, somebody is certain to be upset when guidelines recommend not doing something—even if not doing it represents high-value care.