I had written a reply contradicting post #8 and deleted it. Here is what survived. Side-effect grading scheme has been discussed here with more heat than it deserves, mostly because two definitions have been in play the whole time.
A side-effect grading scheme this community uses, and its limits — the long version — setting out what I have, and where I think it stops being reliable.
A narrow question about side-effect grading scheme, deliberately narrow, because the broad version has been asked here four times and produced four long threads and no answer.
One question, stated units, stated method, and what I have already ruled out.
The opening post and I disagree about the size of the effect, not about the direction.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
Taking post #3 at face value and following it one step further.
Fatigue is commonly described and hard to attribute. Substantial energy restriction produces it on its own, and separating the drug from the deficit requires a change in one and not the other.
Two claims get bundled together under side-effect grading scheme and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
Worth separating two things that post #3 runs together.
Delayed gastric emptying: the mechanism behind much of the gastrointestinal side-effect profile. At extreme magnitudes, severe gastroparesis is a rare but serious complication. Distinguishing ordinary gastrointestinal effects from the rare severe end is a clinical judgement.
I had written a reply contradicting post #8 and deleted it. Here is what survived.
Side-effect grading scheme has been discussed here with more heat than it deserves, mostly because two definitions have been in play the whole time.
Confirming post #8 from a second method, which matters more than confirming it from a second person.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
It is the kind of thing that is obvious once and never again.
On post #10 — agreed on the reasoning, with one qualification.
What I would want before treating side-effect grading scheme as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
The reason side-effect grading scheme keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.
Post #14 describes the usual case. This is about the unusual one.
Taking side-effect grading scheme seriously for a moment rather than deflecting: the honest position is that the community has observations and no controlled comparison, and those two things support very different sentences.
Adding thanks rather than a view. I do not have a view worth the space.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
Recognition and grading: nausea ranges from "noticeable" to "limiting". Constipation ranges from mild to severe. Having language to describe the magnitude helps you track whether something is worsening or stable and helps your clinician understand what you are reporting.
Stating my assumptions rather than smuggling them in.
Confirming post #22 from a second method, which matters more than confirming it from a second person.
Worth stating the null on side-effect grading scheme before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
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