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Table 3 Pros and cons of using the same system for grading evidence and formulating recommendations for a wide range of health care interventions, including clinical and non-clinical interventions

From: Improving the use of research evidence in guideline development: 9. Grading evidence and recommendations

Arguments for having a common approach Arguments against having a common approach
• Having less demanding systems for some kinds of questions might result in false positive conclusions.
• People with vested interests in particular interventions could choose the system that makes their intervention look best.
• People with vested interests in particular evaluation approaches could choose the system that makes their preferred evaluation approach look best.
• Having different systems for different types of interventions might be confusing.
• It is intellectually honest to recognise the limits of evidence where this is appropriate.
• Admitting the limitations of evidence, if this is appropriate, might promote more and better research.
• Having an infeasible system for some kinds of questions might result in false negative conclusions.
• False negative conclusions due to inappropriate evaluation requirements may have negative political and health consequences; for example, effective programs that cannot be studied with randomised trials might experience funding cuts.
• Interventions that cannot be studied with randomised trials might not be evaluated.
• A single system may not discriminate adequately within the range of evidence that is appropriate to consider for clinical and non-clinical interventions.
• A system that can adequately address evidence across a wide range of interventions and contexts may be overly complex.