{"id":1001,"date":"2014-11-03T20:34:04","date_gmt":"2014-11-03T19:34:04","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc\/?p=1001"},"modified":"2014-11-01T18:57:16","modified_gmt":"2014-11-01T17:57:16","slug":"the-crumbling-of-the-pyramid-of-evidence","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2014\/11\/03\/the-crumbling-of-the-pyramid-of-evidence\/","title":{"rendered":"The crumbling of the pyramid of evidence"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"http:\/\/www.ijstd.org\/articles\/2012\/33\/1\/images\/IndianJSexTransmDis_2012_33_1_49_93829_u1.jpg\" alt=\"\" width=\"181\" height=\"136\" \/>The &#8216;old way&#8217; of thinking about the <a title=\"Finding the question\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2009\/12\/19\/finding-the-question\/\">hierarchy of evidence<\/a> was classically envisaged as a systematic review at the top, falling through RCT, cohorts and case-control to expert opinion (and below that, in some iterations, case law &amp; legislative decisions).<\/p>\n<p>There&#8217;s been a move against this, with the <a title=\"GRADE it.\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2013\/04\/03\/grade-it\/\">GRADE system<\/a> as\u00a0explained recently in our popular <a title=\"Guest post: The Systematic Review Speaks The Truth \u2026\u2026 Or Does It?\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2014\/10\/27\/guest-post-the-systematic-review-speaks-the-truth-or-does-it\/\">Guest blog: The Systematic Review Speaks The Truth- or does it?<\/a><\/p>\n<p>Another example has been published in the tricky field of idiopathic scoliosis, where a group have undertaken an <a href=\"http:\/\/www.plosone.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0110254\">overview of systematic reviews<\/a>. What they demonstrate, using the <a href=\"http:\/\/amstar.ca\/\">AMSTAR <\/a>approach of assessing systematic reviews, is\u00a0a huge swath of low-quality reviews\u00a0when assessing\u00a0non-surgical interventions. The conclusions of these reviews appear to be more likely to be &#8216;positive&#8217; than the higher quality reviews, much as expected.<\/p>\n<p>While this message is not startlingly new, it does reinforce the need to <a title=\"Basics. Size vs. bias\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2013\/12\/15\/basics-size-vs-bias\/\">always, always appraise the evidence <\/a>you are looking at. You can do it <a title=\"FAST appraisals\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2010\/03\/07\/fast-appraisals\/\">quickly<\/a>. You can do it <a href=\"http:\/\/amstar.ca\/\">extensively<\/a>. But you need to do it.<\/p>\n<p>&#8211; Archi<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The &#8216;old way&#8217; of thinking about the hierarchy of evidence was classically envisaged as a systematic review at the top, falling through RCT, cohorts and case-control to expert opinion (and below that, in some iterations, case law &amp; legislative decisions). There&#8217;s been a move against this, with the GRADE system as\u00a0explained recently in our popular [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2014\/11\/03\/the-crumbling-of-the-pyramid-of-evidence\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[79],"tags":[],"class_list":["post-1001","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/1001","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=1001"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/1001\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=1001"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=1001"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=1001"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}