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Reply to ‘Shaneyfelt T. Pyramids are guides not rules: the evolution of the evidence pyramid. Evid Based Med 2016;21:121–2’
  1. Brian S Alper1,2,
  2. R Brian Haynes3
  1. 1DynaMed, EBSCO Health, Ipswich, Massachusetts, USA
  2. 2University of Missouri, Columbia, Missouri, USA
  3. 3McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to : Dr Brian S Alper,
    DynaMed, EBSCO Health, 10 Estes Street, Ipswich, MA 01938, USA; balper{at}

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We compliment Dr Shaneyfelt1 on recognising the EBHC pyramid 5.02 as a useful framework to guide the search for answers to clinical questions, especially at the point of care where time is more limited, and for suggesting use of the hierarchy of resources as a guide for searching and as an organisational scheme for evidence resources, and not as explicit rules for defining the evidence to use for a given question.

We agree that within a given …

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