Lost in a jungle of evidence: We need a compass; Practice parameters and technology assessments: What they are, what they are not, and why you should care

I enjoyed reading the articles on classification of evidence by Drs. Gronseth and French.1,2 The authors’ explication of terminology such as “concealed allocation,” “masking,” and “active control equivalence trials” helps put us all on the same footing when attempting to classify articles in the literature. Their recommendation is that future articles should be classified by their respective authors, which would highlight the strength of the findings. I would appreciate the authors’ input on the following questions. 1. Many physicians express disappointment in published Practice Parameters because the quality of the evidence is often too low to produce high-quality recommendations. To what extent is the failure of articles to reach Class I due to lack of “concealed allocation” or other problems that could have been easily remedied in the design and execution of the study (i.e., using sequentially numbered opaque envelopes instead of systematic allocation)? 2. The authors provide clear examples of how articles are classified but how often do the experts disagree when classifying an …