cians engage in informed and shared decision making with patients. It is hoped that it involves reliance on strong evidence, although it is also heavily influenced by personal values of the patient if the decision is to be truly shared with the patient. Quick sound bites do not lend themselves to this format of informed decision making. By contrast, Level 3 involves an across-the-board recommendation for the entire population. Complexities are often sacrificed to strengthen the message. The messages are often sanitized of any mention of potential harms inherent in any test, procedure, or treatment. Here, therefore, recommendations should be based on particularly strong evidence.

Evidence obtained from at least one properly randomized controlled trial Evidence obtained from well-designed controlled trials without randomization

Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group

Evidence obtained from comparisons between times or places with or without the intervention; dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category

Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

From Canadian Task Force on the Periodic Health Examination. Can Med Assoc J 1979;121:1193-1254.

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