Should the application of clinical guidelines be mandatory or recommendatory?

This article discusses the issues associated with the phased introduction of mandatory implementation of clinical guidelines. It is shown that they can be considered as customs, and can be a source of law. The problems of gradual transition to mandatory implementation of clinical guidelines are highlighted and the possible responsibility of medical organizations for their non-compliance is considered. This issue leads to the inclusion in clinical guidelines of drugs and interventions with unproven effectiveness often contradicting modern scientific knowledge. It is proposed to return to the discussion of the mandatory status of clinical guidelines, leaving this requirement for the formation of programs of state guarantees of free medical care to citizens. It is proposed to involve the Russian Academy of Sciences in finalizing the guidelines, as well as to refine their structure by providing sections in it reflecting accumulated knowledge in the field of artificial intelligence and adherence to treatment.