Article Text

other Versions

Download PDFPDF
GRADEing quality of evidence and its importance in evidence-based practice
  1. Anil Kumar1,
  2. Meghana Taggarsi2
  1. 1General and Colorectal Surgery, Stockport NHS Foundation Trust, Stockport, UK
  2. 2General and HPB Surgery, Royal Blackburn Hospital, Blackburn, UK
  1. Correspondence to Dr Anil Kumar, General and Colorectal surgery, Stockport NHS Foundation Trust, Stockport, UK; nettyanil{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


Evidence-based practice forms an integral part of modern-day practice. It is so indispensable that modern healthcare cannot be imagined if evidence and its quality is ignored.1 However, evidence-based medicine is not as perfect as it is thought. Time and again, researchers have questioned the quality of evidence (QOE) in present era’s researches. The evidence in this regard can be found in the article published in The Lancet by the editor himself. Horton argued that much of the scientific literature, nearly 50%, might be false or untrue because of inclusion of small sample size studies, researches with statistically insignificant effects, unfitting analyses, atrocious conflicts of interest, together with an unrestricted fascination to pursue fashionable trends of dubious importance.2

Camouflaged application of evidence-based medicine can be precarious to the patients and may hamper the idea of promoting healthy society.3 According to National Institute for Clinical Excellence, approximately 62% of publications used to formulate the guidelines and recommendations of primary care were based on dubious researches and were judged of uncertain relevance to patients.4

The most recent incident which has raised global concerns on the QOE and how evidence can be tampered can be found from the news printed in The Guardian, where two of the highest ranking international medical journals—New England Journal of Medicine and The Lancet had to retract two papers on COVID-19 pandemic. The Lancet paper, ‘A multinational registry analysis of hydroxychloroquine on COVID-19’, halted global trials on hydroxychloroquine for COVID-19 because of fears of increased deaths from hydroxychloroquine. A thorough introspection later confirmed inconsistencies in the data provision and analysis. Such was the impact of this study that WHO and other countries worldwide had to suspend their randomised control trials (RCT) on the usefulness of hydroxychloroquine on COVID-19.5 Future trials may account …

View Full Text


  • Contributors All the authors contributed substantially to the conception of the study, design, literature search and write-up of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.