**11. Conclusions**

The ongoing use of the flawed CNBSS is the natural consequence of significant systemic problems with the application of guideline methodology and, in Canada, with the unaccountable structure of the CTFPHC. While the practice of medicine requires close adherence to evidence, common sense and clinical judgment are the lenses through which evidence must be filtered. The evidence-based movement has been criticized, even by its proponents, calling for a "return to real evidence based medicine", including "increasing depth of knowledge and sensitivity to context when applying rules" [76].

Making medical recommendations outside one's area of specialty training is not accepted in clinical practice and should not be accepted in the formation of guidelines. Guideline oversight and methodology reform are required to provide appropriate expertise in guideline formulation. As a result of specialists' career-long waitlists and resultant minimal COI, Canada is well positioned to produce excellent guidelines. To achieve these improvements, however, clinicians and patients must advocate for fundamental reform to guideline practices.

**Supplementary Materials:** The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/curroncol29060313/s1. References [77–81] are cited in the Supplementary Materials.

**Funding:** The author received no external funding.

**Acknowledgments:** Many thanks for ongoing advice and historical context provided by Daniel Kopans, Martin Yaffe, Paula Gordon, Jean Seely, and Laurence Klotz, and Jennie Dale.

**Conflicts of Interest:** The author declares no conflict of interest.
