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Where should preappraised evidence summaries and guidelines place in a pyramid?
  1. Fares Alahdab,
  2. Mouaz Alsawas,
  3. M Hassan Murad
  1. Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to : Dr M Hassan Murad
    , Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 200 1st street, Rochester, MN 55905, USA; Murad.Mohammad{at}mayo.edu

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The letter by Kaufmann1 is quite reassuring as it demonstrates that policy researchers have intuitively and astutely questioned simple evidence hierarchies and were sceptical about using study design or study label as a surrogate for validity. This was the impetus for proposing our revised pyramid.

The letter also reminds us that there are higher order scientific publications (guidelines and …

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