Editorial Policy

    Editorial policy

    GreatMed.org provides expert guidance in lifestyle approaches to preventable diseases.  Modules are developed and maintained under the supervision of at least one licensed editor-in-chief in conjunction with the founding physician author. Contents are developed to serve clinicians and patients. Modules are continuously reviewed with topics added or removed as the field evolves.

    All written material is originally prepared by authors and other contributors. This material is reviewed extensively by our founding physician editor and section editor(s) for quality and consistency.  Contributing clinician editors suggest changes so that topics clearly answer common questions, provide clinical guidance, and summarize the relevant evidence.

    Updating

    GreatMed.org is updated and published continuously, rather than publishing according to a specific schedule.  Editors perform a continual review of peer-reviewed journals, clinical databases, and other resources, and topics in GreatMed.org are revised to reflect new information that becomes available. Updates are integrated carefully, with extensive review by our expert contributors to help provide context and clinical guidance.

    Use of Generative Artificial Intelligence, including Large Language Models

    GreatMed.org content is created based on the latest medical literature and the knowledge and expertise of invested clinicians. Authors, editors, and contributors do not use artificial intelligence, including large language models, to create or maintain content. This policy serves to promote the creation and maintenance of original content and reflect editorial standards for quality, transparency, and clarity.

    Evidence

    GreatMed.org summarizes the available lifestyle evidence relevant to each topic and follows a hierarchy of evidence consistent with most evidence-based resources. At the top of the hierarchy are meta-analyses of randomized trials of high methodological quality, followed by individual randomized trials and those with methodological limitations. Observational studies and unsystematic clinical observations provide evidence that is considered lower quality. Inferences are stronger when the evidence is derived from higher-quality studies.

    Each topic has an author(s) who is expert(s) in the area discussed and at least two separate physician contributors/reviewers. This group works together to perform a comprehensive review of the literature and carefully select studies for presentation based on the quality of the study, the hierarchy of evidence discussed above, and the study's clinical relevance. When current, high-quality systematic reviews and/or meta-analyses are available, topics and recommendations may rely on these reviews. When such reviews are unavailable, GreatMed cites relevant successes from current practicing physicians and summarizes the key studies available on the relevant clinical issues. Systematic reviews and primary studies (eg, randomized trials, observational studies) are identified in the text, with the relevant data provided. Users can also review the Medline abstract to obtain additional information by clicking on the reference.

    Evidence is synthesized from many resources, including but not limited to:

    • Continuous review of peer-reviewed journals
    • Electronic searching of databases, including Medline and Cochrane Library
    • Guidelines that adhere to the principles of evidence evaluation described above
    • Published information regarding clinical trials, such as reports from the US Food and Drug Administration (FDA), clinicaltrials.gov, consumerlab.com, natural medicines comprehensive database, national and international disease associations, as well as other sources of information produced by governmental and nongovernmental agencies to the extend the information contributes to overall population health according to practice experience, clear evidence, and fundamental critical thinking.
    • Proceedings of major national and international scientific meetings
    • The clinical experience and observations of our authors, editors, and peer reviewers

    Recommendations

    Making recommendations

    GreatMed.org’s process of arriving at recommendations involves constructing structured clinical questions. That structure includes carefully defining the patient population of interest, the alternative management strategies, and the outcomes of importance to patients (PICO format: Population, Intervention, Comparators, Outcomes).  Simply put, GreatMed.org aims to outline what works and what does not work in lifestyle as a primary means of disease prevention, management, and reversal.

    Recommendations by GreatMed.org are based on a synthesis of evidence, including that obtained from clinical trials as well as clinical experience; the evidentiary basis for recommendations is stated explicitly. When there is no published systematic evidence available, recommendations are based on the unsystematic clinical observations of our experts and reviewers, historical support, and on pathophysiologic rationale. Some evidence-based resources avoid making specific recommendations for patient care when high-quality studies are lacking. GreatMed.org makes practical recommendations for disease prevention and management whenever possible based on the rationale above; most lifestyle recommendations benefit overall health both in the absence or presence of disease.

    Decision makers must always trade the benefits and risks, inconvenience, and costs associated with alternative management strategies, and in doing so consider the patient's values".1 Expertise is thus required to move from evidence to recommendations.  GreatMed.org recommendations identify situations in which different approaches might be appropriate based on specific patient characteristics and/or patient preferences.  GreatMed.org recommendations call out the duty of the clinician to approach lifestyle in caring for all patients at risk for disease, independent of the clinician’s perceived likelihood of the patient’s participation.  Clinicians using GreatMed.org’s approaches may become motivated to enhance their motivational interviewing approaches as the recommendations found at GreatMed.org often require more effort on the patient’s part than other pharmaceutical-forward approaches.