In 2011, the Institute of Medicine laid out standards for clinical practice, in the hopes of ensuring that patients receive the highest quality of care. Among the standards are disclosing conflicts of interests, using systematic reviews of the literature, seeking external review and regularly updating recommendations. A new study examined 169 clinical practice guidelines of the four leading causes of cancer death in the U.S. (lung, colorectal, prostate, and breast) to see how well they met the IOM’s standards. The results were discouraging; the average guidelines met just 2.75 of the 8 major criteria, and only 8.24 of 20 sub-criteria. However, the researchers who performed the investigation said that the guidelines were still very strong, and questioned the pragmatism of the standards drawn up by the IOM, which could be overly strict.