Intended for healthcare professionals

Rapid response to:

Short Reports

Seven alternatives to evidence based medicine

BMJ 1999; 319 doi: (Published 18 December 1999) Cite this as: BMJ 1999;319:1618

Rapid Response:

Evidence based medicine rating scale

I read the paper of Isaacs and Fitzgerald with great interest and
amusement. I am a skeptical proponent of evidence-based medicine, but
would add the definition that it is a system of belief that requires
prospectively collected objective evidence of everything except its own
utility. In the same vein as Issacs and Fitzgerald, I suggest the
adoption of the following as a realistic evidence-based rating scale:

Class 0: things I believe

Class 0a: things I believe despite the available data

Class 1: randomized, controlled clinical trials (RCCTs) that agree
with what I believe

Class 2: other prospectively collected data

Class 3: expert opinion

Class 4: RCCTs that don't agree with what I believe

Class 5: what you believe that I don't

Competing interests: No competing interests

18 December 1999
Thomas P Bleck
Professor of Neurology, Neurological Surgery, and Internal Medicine
University of Virginia, USA