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There isn't that much arithmetic involved, simply rating different levels of evidence from very low to strong. Could you give an example of something that is not simply wrong but badly wrong/abhorrence? in the GRADE handbook

GRADE has a lot of issues but I don't think it's the main problem here. It's the authors. Most of what is in the handbook seem reasonable, nothing as absurd or counterintuitive as what Busse et al. are proposing. GRADE doesn't say that committees should make recommendations for a treatment...

I think GRADE simply gives guidance to committees and panels in cases where they would like or are forced to make recommendations. But it doesn't suggest that recommendations should be made. That seems like the only reasonable explanation. Does NICE have to make a recommendation for or against...

Very low quality is the lowest the GRADE system goes. That's the level of case reports etc. See for example: So if very low quality evidence should lead to a recommendation, then NICE would have to recommend everything (carnitine, LDN, Ampligen) that has scientific studies in support, no matter...

No I think this is simply a precaution to not make strong recommendations when things are unclear. The full section reads (my bolding) so it seems that the 'more cautious' refers to more cautious than making a strong recommendation. If the evidence was unclear or unconvincing the cautious...

Thanks. I had to shorten it a bit because it was originally too long.

Only read the abstract, but this looks like a good example of the inappropriate use of questionnaires. I could make a diabetes questionnaire with nonspecific symptoms that occur in patients with diabetes such as thirst, fatigue etc. I then offer the diabetes questionnaire to a group of CFS...

Yes the evidence isn't overwhelming (because there isn't much data that compared case definitions) but it does suggest that oxford results in much higher prevalences and thus risk overdiagnosing patients with ME/CFS. Made a Twitter thread about it in response to Alan Car.

Thanks very much, change it. Aha! Good to know!

Yes thanks Andy - updated it asap.

I've written a blog (with the help of Evelien) where I analyse the rapid response by Guyatt and colleagues. https://mecfsskeptic.com/the-nice-guideline-committee-and-grade-methodology/

NICE has made summaries of qualitative research (such as studies that performed interviews to see how they experience GET etc.). It also commissioned surveys on experiences on GET/CBT, experiences of children with ME/CFS and patients with severe ME/CFS - I suspect that's what he is referring to...

Thanks will do so. Would this work: "The first and foremost principle of rating quality of evidence should be to understand the specifics of what is being assessed. One has to understand the nature of the intervention and how it is supposed to impact patients. Thanks for all the helpful...

I agree. Well done Caroline! Yes I also think that this extra sentence would be useful. Really hope they will do it. Thanks @Caroline Struthers

Thanks for the helpful suggestions @Esther12 @cassava7 @MSEsperanza . I have adjusted my commentary accordingly. The more I look into this, the more have the impression that Guyatt and colleagues view is directly at odds with what the GRADE handbook recommends. As Jonathan has pointed out...

As Esther noted, NICE rated all the evidence in support of GET as low to very low quality. But the Cochrane review actually did the same with only one exception: fatigue measured post-treatment which was rated as moderate quality. So not exactly a big difference. According to Gordon Guyatt...

Don't think so. The main difference seems to be that the Cochrane review has thrown all of the different types of GET interventions into one big comparison while NICE has made different tables for many of them. The approach by Cochrane is useful if you want to see the effect when all...

It's simply a case report - don't think it means much to be honest.

I'm thinking about submitting the following rapid response - any suggestions before I do so? ----------------------------------------- I would like to respond to the comment by Jason Busse and colleagues as it includes some remarkable statements. The authors criticize the NICE guidance...