For the decade ending in 2007, an average of 920 days was spent to write each of the various American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) guidelines. For comparison, this is the same amount of time required to build the first atomic bomb (September 1942 to April 1945) and the Gateway Arch in St. Louis (February 1962 to October 1965).

The recently published “2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction” runs to 64 pages of fine print, plus another 17 pages of data supplements, plus 6 more pages of author disclosures. Even the executive summary is 27 pages in length (plus the data supplements and author disclosures). It is unclear for whom such cumbersome guidelines are written. It is quite possible that all of the various ACCF and AHA guidelines currently extant total a million or more words, rivaling in length and complexity the tax code of the Internal Revenue Service. It is conceivable that the word count of all of the guidelines for all the various specialties and subspecialties in all branches of medicine totals tens of millions of words. Compare this with the Ten Commandments. The first 4 concern how one should worship God. The last 6, which run barely 80 words, concern how one should interact with one’s fellow man and have adequately governed Western society for more than 3 millennia.

At a recent conference, I suggested that rather than forcing practitioners to blindly comply with the myriad regulations that have permeated medicine, those who formulate these regulations justify to us why so many are required. I was told that “resistance is futile.” If that is how you feel, then resistance is indeed futile. The goal of bureaucracy is perfection. There is no perfection. The best guidelines are simple and serve a purpose. It is quite possible that if the world’s 10 most recognized experts on any topic were put together for 1 day and allowed to use their judgment, they could draw up quite adequate guidelines on any subject. Because that solution is too simple, I propose that the budget, time frame, and word count for the next guidelines due for update be cut by at least 2/3 compared with the previous endeavor. They will not be perfect, but neither are the current guidelines. Instead, they will be as good or better, much simpler, and of far more practical use.

The entire process of formulating guidelines is in need of overhaul. I submit that the time of our most gifted physicians would be better spent taking care of patients and that the money expended would be better spent funding research rather than writing guidelines that are beyond the utility of practicing physicians and are as long and complex as the federal tax code.