Opinion | The “evidence pyramid” should be dismantled, brick by ill-conceived brick

Summary: The text criticizes the use of the so-called “evidence pyramid” in medicine, which suggests that systematic reviews and meta-analyses (SRMAs) are the highest level of evidence in medicine. The author argues that SRMAs are not evidence themselves, but a lens through which actual evidence from randomized controlled trials (RCTs) and observational studies is viewed. They depend on the quality of the review process and the evidence appraised, which are often low quality and small studies with various methodologies. The author suggests that a better framework would place RCTs at the top of the pyramid and relegates SRMAs to the role of a lens. The author also points out that good observational studies may be better than bad RCTs, and that each paper should be read and judged on its individual merits, not by its strata on a pyramid.

(By ChatGPT, reviewed and edited)

Source: The “evidence pyramid” should be dismantled, brick by ill-conceived brick – Sensible Medicine