Re: Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study
I read with great interest the paper by Korownyk et al. BMJ 2014;349:g7346. Although I agree with the general conclusion of the paper regarding the lack of evidence to support several particular recommendations, I found methodological deficiencies or uncertainties that were not properly conducted or explained by authors. This situation harms the validity of the main findings.
Searching evidence for recommendations is an objective process. However, the assessment of quality of the evidence is subjective and should be systematic and transparent; the information provided by authors as supplement is largely insufficient.
Several evaluated recommendations were indeed vague, and should be delivered with the warning that there is no enough evidence supporting them. Recommendations backed by scientific organizations and only based on expert opinions are not the best evidence. Importantly, the strength of recommendations is based not only on efficacy or effectiveness evidence from studies, but also on costs and patient values and preferences (1).
Developing searchable questions for vague recommendations is difficult. Authors made a good effort developing those questions, but several of the questions seem incomplete or erroneous in a closer examination of the results. Authors explained their broad and inclusive approach, but still some questions failed in finding the best evidence.
Finally, according to authors conflicts of interest were not declared by most of the guests of the medical show. I understand that US network broadcasters are compelled to report any conflicts of interest, and not revealing a conflict is illegal. I think this had to be explained to the non-American readers given the worldwide focus of the BMJ.
1. Andrews JC et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013;66:726-35.
Rapid Response:
Re: Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study
I read with great interest the paper by Korownyk et al. BMJ 2014;349:g7346. Although I agree with the general conclusion of the paper regarding the lack of evidence to support several particular recommendations, I found methodological deficiencies or uncertainties that were not properly conducted or explained by authors. This situation harms the validity of the main findings.
Searching evidence for recommendations is an objective process. However, the assessment of quality of the evidence is subjective and should be systematic and transparent; the information provided by authors as supplement is largely insufficient.
Several evaluated recommendations were indeed vague, and should be delivered with the warning that there is no enough evidence supporting them. Recommendations backed by scientific organizations and only based on expert opinions are not the best evidence. Importantly, the strength of recommendations is based not only on efficacy or effectiveness evidence from studies, but also on costs and patient values and preferences (1).
Developing searchable questions for vague recommendations is difficult. Authors made a good effort developing those questions, but several of the questions seem incomplete or erroneous in a closer examination of the results. Authors explained their broad and inclusive approach, but still some questions failed in finding the best evidence.
Finally, according to authors conflicts of interest were not declared by most of the guests of the medical show. I understand that US network broadcasters are compelled to report any conflicts of interest, and not revealing a conflict is illegal. I think this had to be explained to the non-American readers given the worldwide focus of the BMJ.
1. Andrews JC et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013;66:726-35.
adrianhernandezdiaz@gmail.com
Competing interests: No competing interests