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Record W3217524044 · doi:10.1136/bmj.n2833

Can we trust strong recommendations based on low quality evidence?

2021· editorial· en· W3217524044 on OpenAlex
Liang Yao, Gordon Guyatt, Benjamin Djulbegović

Why this work is in the frame

A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.

affAt least one author lists a Canadian institution in the pinned OpenAlex snapshot.

Bibliographic record

VenueBMJ · 2021
Typeeditorial
Languageen
FieldMedicine
TopicClinical practice guidelines implementation
Canadian institutionsMcMaster UniversityImpact
FundersAgency for Healthcare Research and Quality
KeywordsHarmQuality (philosophy)Quality of evidenceTrustworthinessCertaintyMedicineScientific evidenceActuarial scienceEvidence-based medicineRisk analysis (engineering)Adverse effectPsychologyBusinessAlternative medicineSocial psychologyRandomized controlled trialSurgery

Abstract

fetched live from OpenAlex

A necessary requirement for development of trustworthy guidelines is to respect the relation between the quality (certainty) of evidence and strength of recommendations. Strong recommendations are justified when they are based on high quality evidence, because such recommendations are considered more accurate.1 On the other hand, uncertainty in benefits and harms (that is, low quality evidence) generally leads to weaker recommendations. The failure to recognise this important principle results in a tendency to issue strong recommendations based on low quality evidence (which we call discordant recommendations), often leading to harm. For instance, based on advice from low quality evidence, women have experienced avoidable adverse effects from hormone replacement therapy prescribed for the prevention of cardiovascular disease; and …

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.004
metaresearch head score (Gemma)0.128
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesMetaresearch, Meta-epidemiology (narrow), Insufficient payload (model declined to judge)
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: Not applicable
GenreCandidate signal: Editorial · Consensus signal: Editorial
Teacher disagreement score0.270
Threshold uncertainty score1.000

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0040.128
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0010.001
Insufficient payload (model declined to judge)0.0030.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.382
GPT teacher head0.583
Teacher spread0.201 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it