Modifying the GRADE framework

could benefit public health The commitment in recent years to ensuring that rigorous evidence is available to guide medical practice and health policy making is commendable. To guide the assessment of evidence, various approaches have emerged in recent years. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework has enjoyed particular popularity, providing a systematic and intelligible approach to ranking available research outcomes.1 The merits and limitations of the GRADE framework for systematically evaluating the quality of evidence for guiding clinical practice guidelines have recently been eloquently debated.2 3 We will not dwell on the methodological allegations that GRADE suffers from external and internal inconsistency, potential for bias and lack of validation, nor the possibility tha