Journal of clinical epidemiology
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We previously claimed that the credibility ceiling for meta-analyses is fundamentally flawed. We respond to Dr. Ioannidis' rebuttal of those claims. ⋯ Given that the crux of our argument remains unaddressed, we continue to recommend against use of the credibility ceiling method. We are, however, sympathetic to what seem to be the underlying aims of the method, if not the execution. Developing principled methods to address those aims would be useful.
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The public, policy makers, and science communities are subject to many false, uninformed, overly optimistic, premature, or simply ridiculous health claims. The coronavirus disease 2019 (COVID-19) pandemic and its context is a paramount example for such claims. In this article, we describe why expressing the certainty in evidence to support a decision is critical and why the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach matters now, perhaps more than ever and no matter what the specific topic is in relation to COVID-19. We finally also offer suggestions for how it can be used appropriately to support decision-making at global, national, and local level when emergency, urgent or rapid responses are needed. ⋯ Assessing and communicating the certainty of evidence during the COVID-19 pandemic is critical. Those offering evidence synthesis or making recommendations should use transparent ratings of the body of evidence supporting a claim regardless of time that is available or needed to provide this response.
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The "credibility ceiling" method was proposed to conduct sensitivity analysis for unmeasured confounding and other forms of bias in meta-analyses and has been used in umbrella reviews to grade evidence strength. However, we explain that the method has fundamental statistical flaws. ⋯ Given the fundamental problems with the credibility ceiling method and its demonstrated potential for misleading conclusions, we recommend against its use.