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I see now what 'transparent' is supposed to mean - to have the reasoning explicit. But GRADE does not do this. It just requires that you say you downgraded one pip for bias and one pip for indirectness or whatever. Does it require you to say what your reasons are? I think it would be better...

I was hoping someone would disagree with me to point out where I am arguing badly. But still time for that!

Interesting: That would seem to make a mockery of Busse et al.'s claim that GRADE had been disastrously misapplied. Clearly the GRADE people think they are telling others how decisions should come out. Moreover, if GRADE is being used by technical staff who have no experience of the psychology...

Looking at the BMJ 'What is GRADE' and the opening para of 'How does it work?' the following sentence is interesting: An overall GRADE quality rating can be applied to a body of evidence across outcomes, usually by taking the lowest quality of evidence from all of the outcomes that are critical...

I think the BMJ What is GRADE is a reasonable place to get an overview. The GRADE manual is long, although it is reasonably easy to locate various aspects.

And this is very odd wording. It seems to indicate either a lack of understanding of probability or a hidden assumption that the result was 'fiddled'. If the accuracy of the estimated effect is just plain uncertain the true effect is most probably something like it but might be quite different...

The point about giving some sort of positive value to evidence, however flawed, is also a salient one, yes. Any system like GRADE should recognise evidence that makes it highly likely that there was no effect as for PACE. GRADE deals with this by noting the consistency of any positive finding...

The idea of GRADE to provide a recipe for making decisions for people who are not themselves capable of making such decisions on their own is a flawed and dangerously counterproductive idea in a medical context. The pseudo-arithmetic structure of allocating evidence to 'grades' has no purpose...

Yes, it is revealing. The essence of Busse and Guyatt's beliefs about fibromyalgia appears to be: 'Belief that fibromyalgia is caused by an underlying physical lesion is associated with concern that exercise is harmful for this patient population; both beliefs could be detrimental to...

So what on earth is that supposed to mean. What is a reproducible framework, other than one that can be printed on several pieces of paper? And in what sense is it transparent - or is that the paper too! So it is just a set of hoops to jump through as in Lilliput it seems. And since the...

Let's face it, Garner has been handing out judgments about people he doesn't;t like for the moment all along. First nobody was interested in his protracted illness, then they were too interested, then the NICE committee caved in to activity and in the meantime everyone except him is too flabby...

Like results in psychosomatic research then - all in the mind of the researcher? Makes sense.

I think it is remarkable how few people have put their heads above the woodwork parapet. Once NICE decided there were bound to be various 'Disgruntled of Tunbridge Wells Rehab Unit' messages. All of the comments I have seen so far are from people otherwise never heard of. Busse dragged Guyatt...

"That would be a disastrous misapplication of GRADE." But in what senses? As I understand it all applications of GRADE are misapplications since the tool has no validity - and I think at least Caroline would agree. (It is far from clear that the example would even be a misapplication within...

She is obliged to do it that way by academic rules. I had to do the same.

An additional point is that within medical science formal debate on the most rational interpretation of evidence very rarely occurs and most medical academics are uncomfortable with it - probably because it might expose their inability to think clearly. In contrast it is something we do a lot...

There isn't any real arithmetic but there is enough pseudo-arithmetic to matter. The pseudo-arithmetic consists of giving grades of reliability 1,2,3.. and then saying that you are allowed to shift one or two numbers on the scale - as if this were some sort of 'objective numerical' scale when it...

Thanks for flagging this @Woolie. This is a nice ironic illustration of the core problem the GRADE enthusiasts and Cochrane reviewers seem to find hard to understand. Perhaps I could have cited this and Hrobjartsson in my testimony to NICE. The citation of Hrobjartsson is interesting, though...

But perhaps not if the lack of scientific integrity consisted of pretending to have lack of scientific integrity in order to have one's own paper retracted because the result caused a problem for one's practice income stream?

I strongly but amicably disagree, @Michiel Tack. GRADE is an obscenity. It replaces rational analysis with pseudo-arithmetic. There is no possible justification for that. And it get things badly wrong. It is an abhorrence. It is totally counterintuitive to replace direct argument from evidence...