Clinical review or Hypothesis?

I thank Dr Genuis and Mr Tymchak for presenting their interesting article, “Approach to patients with unexplained multimorbidity with sensitivities.”¹ As they point out, these unfortunate patients do present us with both diagnostic and therapeutic dilemmas. However, I think this article more properly belongs in the Hypothesis section of the journal rather than the Clinical Review section.

According to Canadian Family Physician guidelines, clinical review articles in the “Update” category should give a “practical and comprehensive overview of diagnosis and treatment.”² I was disappointed that the only guidance to the reader for diagnosis and treatment consisted of the sentences “a diagnosis of SRI [sensitivity-related illness] should be considered whenever a presentation of plural diagnoses or multisystem complaints exists with associated food or chemical sensitivities” and “management strategies can be found in recent scientific literature.”¹ I find these recommendations neither comprehensive nor practical.

The guidelines for authors² also request the inclusion of a section on quality of evidence and ask of authors, “When recommendations are based on specific evidence, provide references and give level of evidence.” Despite the extensive reference list attached by the authors, there was no attempt to describe the actual evidence or even appraise or grade it. I can only assume that despite the existing research, there is not enough evidence to make recommendations, even those highlighted as key points by the editor.

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