The article by Weeramanthri et al (2002) provides an invaluable account of the processes, endeavours and benefits derived from the development and use of disease guidelines for Indigenous populations. It highlights several important lessons from which others with a similar interest can benefit, including the following:

• the importance of obtaining a consensus, and not just an evidence base, for guideline development

• guidelines should be judged in relation to what already exists rather than in relation to a hypothetical standard of best practice

• implementation is far more difficult than development. The term evidence, in this context, is often used to refer to proof of benefit derived from quasi-experimental design studies.

However, one should not discount the use of other forms of evidence, particularly (in the absence of evidence from studies with an adequate experimental design) experiential-based evidence.

I focus on two related matters in this commentary. The first concerns the extent to which the experiences of these two trials are similar to or contrasted by the experiences of the other Indigenous trials. The second concerns lessons learned from implementation and usage of disease guidelines as distinct from development issues which are the focus of the article by Weeramanthri and colleagues.