A nice insight and critique. I have a few additional comments. Most evidence is low which is important. I think physician Gestalt which is vilified by the PC is still very valuable because it includes the physician’s independent input. These are only guidelines and should not be used by others including insurance companies or Pharmaceutical companies otherwise. The report says that. The Guideline report uses reference 16 – where the authors changed the term PGA Physicians Global Assessment to Provider Global Assessment. I objected to that then and now. But the Guideline paper uses the term "clinician" throughout rather than "physician". PC is not scientific and lessen the physician who has the ultimate responsibility. I also object to the limited Disease activity measures (DAM) from reference 16 as though this is the only reliable reference. These DAM Minimal Clinical Differences have a wide Coefficient of variation which is beyond the scope of the paper but it should not be if these are being solely used without critique. It also ignores the VectraDA which I think is a very good guide - but not 100 % either. It is a guide like the other DAMs with good scientific support.