{
  "name": "Baseline evidence grades",
  "description": "A six-grade rubric applied to tests and interventions in preventive medicine, with every standing grade and the condition under which it would change.",
  "url": "https://www.baseline-media.com/method/",
  "license": "CC BY 4.0. Attribute to Baseline (baseline-media.com)",
  "publisher": "USP COMMERCE S.L.U.",
  "note": "Grades apply to a test or intervention for a stated purpose in a stated population. They never apply to a company.",
  "rubric": [
    {
      "grade": "A",
      "meaning": "Randomised trial evidence of benefit on a hard outcome (mortality, or morbidity that matters to patients), replicated."
    },
    {
      "grade": "B",
      "meaning": "Consistent evidence of benefit, but from trials with surrogate endpoints, single trials, or strong longitudinal cohorts."
    },
    {
      "grade": "B-",
      "meaning": "Promising trial evidence that does not yet reach a hard outcome, or a single registrational study without independent replication."
    },
    {
      "grade": "C",
      "meaning": "Mechanistically plausible and widely used, but no trial evidence of net benefit in the screened population."
    },
    {
      "grade": "C-",
      "meaning": "Plausible with documented harms that are not yet quantified against the benefit."
    },
    {
      "grade": "D",
      "meaning": "Marketed ahead of its evidence. Measurement is unreliable, or the claimed inference is not supported."
    }
  ],
  "grades": [
    {
      "subject": "Coronary calcium",
      "grade": "B",
      "headline": "The cardiac test with the best guideline support is missing from almost every premium check",
      "url": "https://www.baseline-media.com/articles/coronary-calcium-the-test-nobody-includes/",
      "keyFindings": [
        "The 2018 ACC/AHA cholesterol guideline states that coronary artery calcium scoring is reasonable to guide the clinician-patient risk discussion in asymptomatic adults aged 40 to 75 with LDL-C 70 to 189 mg/dL and 10-year ASCVD risk of 7.5% to under 20%.",
        "In MESA, calcium measurement significantly improved risk classification among intermediate-risk individuals, with roughly 40% of those scoring zero reclassified downward.",
        "German law requires a rechtfertigende Indikation for every CT under §83 StrlSchG. There is currently no justified indication for standalone calcium scoring as a screening method, so it cannot lawfully be sold as a routine programme component in Germany.",
        "That legal constraint, rather than commercial reluctance, is the main reason German programmes omit it. Providers can and do offer it on individual medical indication instead.",
        "Calcium scoring also requires CT, so MRI-based programmes cannot produce one without abandoning the radiation-free position that is their main safety argument."
      ],
      "assessed": "2026-08-26",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "2018 AHA/ACC multisociety guideline on the management of blood cholesterol: coronary artery calcium recommendations for intermediate-risk adults.",
          "url": "https://www.acc.org/Latest-in-Cardiology/Articles/2021/10/12/12/46/New-Evidence-Supporting-Selective-Use-of-Coronary-Artery-Calcium-Scoring"
        },
        {
          "citation": "Utility of coronary artery calcium scoring in low-risk patients: the Multi-Ethnic Study of Atherosclerosis (MESA).",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12557561/"
        },
        {
          "citation": "Warranty period of a calcium score of zero: comprehensive analysis from MESA. JACC: Cardiovascular Imaging.",
          "url": "https://www.jacc.org/doi/10.1016/j.jcmg.2020.06.048"
        },
        {
          "citation": "National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. Journal of Clinical Lipidology.",
          "url": "https://www.lipidjournal.com/article/S1933-2874(20)30342-1/fulltext"
        },
        {
          "citation": "Coronary artery calcium scoring: an adjunct to risk stratification, not a replacement for it. American Journal of Medicine.",
          "url": "https://www.amjmed.com/article/S0002-9343(26)00208-1/fulltext"
        },
        {
          "citation": "Die rechtfertigende Indikation nach dem geänderten Strahlenschutzrecht. RöFo / Thieme.",
          "url": "https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-1752-7099.pdf"
        },
        {
          "citation": "Wissenschaftliche Bewertung und rechtliche Zulassung von radiologischen Früherkennungsuntersuchungen in Deutschland. Die Radiologie.",
          "url": "https://link.springer.com/article/10.1007/s00117-020-00758-3"
        },
        {
          "citation": "Rechtfertigende Indikation: Grundlagen und Beispiele. Ärztliche Stelle Hessen / TÜV SÜD.",
          "url": "https://www.tuvsud.com/de-de/-/media/de/aerztliche-stelle-hessen/pdf/broschueren-und-flyer/tuev-sued-erstellung-rechtfertigende-indikatoren-hessen.pdf"
        },
        {
          "citation": "Qualitätskriterien für die Erbringung kardialer CT-Leistungen. Die Kardiologie.",
          "url": "https://link.springer.com/article/10.1007/s12181-023-00599-z"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. Programme comparison: Core, Evolve and Ultimate.",
          "url": "https://years.co/en"
        }
      ]
    },
    {
      "subject": "Cardiorespiratory fitness",
      "grade": "B",
      "headline": "The best-evidenced number in any premium health check is the one nobody markets",
      "url": "https://www.baseline-media.com/articles/vo2-max-the-best-evidenced-number/",
      "keyFindings": [
        "In 122,007 adults undergoing treadmill exercise testing at the Cleveland Clinic, with median follow-up of 8.4 years, the least-fit group had roughly five times the all-cause mortality of the elite-fit group.",
        "Fitness was inversely associated with long-term mortality with no observed upper limit of benefit. Performance at two or more standard deviations above the age and sex mean carried the lowest adjusted mortality of any group.",
        "The benefit held in older patients and in those with hypertension, the two groups most often advised to be cautious about hard exertion.",
        "A cardiopulmonary exercise test costs a fraction of a whole-body MRI and is included by fewer than half the providers in the Baseline Index."
      ],
      "assessed": "2026-07-30",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "Mandsager K, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. 2018;1(6):e183605.",
          "url": "https://pubmed.ncbi.nlm.nih.gov/30646252/"
        },
        {
          "citation": "Mandsager K, et al. Full text, Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing.",
          "url": "https://caringambassadors.org/wp-content/uploads/2018/10/Mandsager_2018_Exercise_Mortality.pdf"
        },
        {
          "citation": "Impact of cardiorespiratory fitness and diabetes status on cardiovascular disease and all-cause mortality: an NHANES retrospective cohort study.",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11059329/"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. Programme comparison: Core, Evolve and Ultimate.",
          "url": "https://years.co/en"
        }
      ]
    },
    {
      "subject": "Bone density and body composition",
      "grade": "B",
      "headline": "DEXA is well evidenced for the thing nobody sells it for",
      "url": "https://www.baseline-media.com/articles/dexa-what-its-actually-for/",
      "keyFindings": [
        "The USPSTF recommends bone mineral density screening by DEXA for all women aged 65 and over, and for postmenopausal women under 65 with one or more risk factors, finding moderate net benefit. The recommendation was updated on the basis of new evidence across 28 publications.",
        "For men, the USPSTF found insufficient evidence to make a recommendation either way.",
        "Age is a stronger determinant of fracture than bone density. Older adults fracture at much higher rates than younger adults with identical BMD, because bone quality declines and falls risk rises.",
        "The grade applies to bone density screening in the recommended population. Body composition by DEXA is a separate use with good measurement precision and no outcome evidence for serial tracking in healthy adults."
      ],
      "assessed": "2026-08-23",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "US Preventive Services Task Force. Screening for osteoporosis to prevent fractures: recommendation statement.",
          "url": "https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening"
        },
        {
          "citation": "USPSTF boosts DEXA in osteoporosis screening. AuntMinnie.",
          "url": "https://www.auntminnie.com/clinical-news/digital-x-ray/article/15712019/uspstf-boosts-dexa-in-osteoporosis-screening"
        },
        {
          "citation": "US Preventive Services Task Force. Screening for osteoporosis: evidence summary.",
          "url": "https://www.uspreventiveservicestaskforce.org/home/getfilebytoken/hhrqMCEgbsBMJ_Ppbcp4yJ"
        },
        {
          "citation": "Screening for osteoporosis. NCBI Bookshelf, introduction and background.",
          "url": "https://www.ncbi.nlm.nih.gov/books/NBK45204/"
        },
        {
          "citation": "Dual energy X-ray absorptiometry scanning for osteoporosis detection: analysis of patients at a tertiary care hospital.",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544949/"
        }
      ]
    },
    {
      "subject": "Multi-cancer early detection",
      "grade": "B-",
      "headline": "The cancer blood test finally has a big trial. Read the sensitivity number twice.",
      "url": "https://www.baseline-media.com/articles/mced-blood-tests-after-pathfinder-2/",
      "keyFindings": [
        "In PATHFINDER 2 (n=35,878, adults aged 50 and over with no clinical suspicion of cancer), Galleri showed episode sensitivity of 39.3% across all cancers with specificity of 99.6%, a false positive rate below 0.4%.",
        "For the 12 cancers responsible for roughly two-thirds of US cancer deaths, episode sensitivity was 73.7%. The all-cancer figure and the deadly-cancer figure describe different things and are not interchangeable.",
        "Added to USPSTF grade A and B screening, the test increased cancer detection more than seven-fold. Screening four times detected four times as many cancers as standard of care alone.",
        "The NHS-Galleri randomised trial observed a reduction in stage IV cancers of more than 20%. Cancer signal of origin was predicted with over 90% accuracy.",
        "At 39.3% all-cancer sensitivity the test supplements guideline screening and cannot replace it. A negative result rules out very little."
      ],
      "assessed": "2026-09-04",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "GRAIL. PATHFINDER 2 results in more than 35,000 participants, presented at the 2026 ASCO Annual Meeting.",
          "url": "https://grail.com/press-releases/grail-presents-pathfinder-2-results-of-more-than-35000-participants-showing-the-galleri-test-substantially-increased-cancer-detection-with-robust-performance-and-favorable-safety-at-2026-a/"
        },
        {
          "citation": "GRAIL. PATHFINDER 2 results show Galleri increased cancer detection more than seven-fold when added to USPSTF A and B recommended screenings.",
          "url": "https://grail.com/press-releases/grail-pathfinder-2-results-show-galleri-multi-cancer-early-detection-blood-test-increased-cancer-detection-more-than-seven-fold-when-added-to-uspstf-a-and-b-recommended-screenings/"
        },
        {
          "citation": "PATHFINDER 2 trial releases positive topline data for multicancer early detection test. OncLive.",
          "url": "https://www.onclive.com/view/pathfinder-2-trial-releases-positive-topline-data-for-multicancer-early-detection-test"
        },
        {
          "citation": "GRAIL announces positive top-line results from the Galleri PATHFINDER 2 registrational study.",
          "url": "https://grail.gcs-web.com/news-releases/news-release-details/grail-announces-positive-top-line-results-gallerir-pathfinder-2"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. Programme comparison: Core, Evolve and Ultimate.",
          "url": "https://years.co/en"
        }
      ]
    },
    {
      "subject": "Biomarker panels",
      "grade": "C",
      "headline": "What does 230 biomarkers buy you that 89 does not?",
      "url": "https://www.baseline-media.com/articles/what-230-biomarkers-buys/",
      "keyFindings": [
        "Panel sizes in the Baseline Index run from about 70 datapoints at Neko Health to 230 at the top YEARS tier and 200-plus at Fountain Life.",
        "The first 20 markers carry most of the decision weight. Lipids, HbA1c, kidney and liver function, thyroid, full blood count and inflammatory markers cover the majority of actionable findings in asymptomatic adults.",
        "Marker count and marker value diverge sharply above roughly 60 analytes, because additional markers are increasingly either research-grade, highly correlated with markers already measured, or not actionable in an asymptomatic person.",
        "The strongest argument for a large panel is not detection but baseline: knowing your own normal makes a future deviation interpretable in a way a population reference range cannot."
      ],
      "assessed": "2026-08-13",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "YEARS. Programme comparison: Core, Evolve and Ultimate biomarker counts and modality coverage.",
          "url": "https://years.co/en"
        },
        {
          "citation": "Fountain Life memberships: CORE, APEX and APEX Family.",
          "url": "https://www.fountainlife.com/membership"
        },
        {
          "citation": "Full-body scans and preventive health: provider comparison. New Market Pitch, 2026.",
          "url": "https://newmarketpitch.com/blogs/news/longevity-preventive-health-startup"
        },
        {
          "citation": "O'Sullivan JW, et al. Prevalence and outcomes of incidental imaging findings. BMJ. 2018;361:k2387.",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249611/"
        }
      ]
    },
    {
      "subject": "Screening imaging",
      "grade": "C",
      "headline": "Whole-body MRI has never been shown to save a life",
      "url": "https://www.baseline-media.com/articles/whole-body-mri-evidence/",
      "keyFindings": [
        "No randomised controlled trial has shown that whole-body MRI or CT screening reduces mortality or morbidity in asymptomatic adults. The question is open rather than answered.",
        "In apparently asymptomatic adults, pooled prevalence of critical incidental findings was 13.4% (95% CI 9.0 to 19.5). Adding indeterminate findings brings the combined figure to 32.1% (95% CI 18.3 to 50.1).",
        "A meta-analysis pooling more than 9,000 asymptomatic people found a modest cancer detection rate alongside unstandardised protocols, high incidental finding rates and no cost-effectiveness data.",
        "Absence of outcome evidence is not evidence of absent benefit. It does mean any provider selling the scan on a survival claim has moved ahead of the literature."
      ],
      "assessed": "2026-07-15",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "Kwee RM, Kwee TC. Whole-body MRI for preventive health screening: a systematic review of the literature. Journal of Magnetic Resonance Imaging. 2019;50(5):1489-1503.",
          "url": "https://pubmed.ncbi.nlm.nih.gov/30932247/"
        },
        {
          "citation": "Whole-body MRI or CT screening for reducing morbidity and mortality from multiple diseases in asymptomatic adults. Cochrane Database of Systematic Reviews.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13504611/"
        },
        {
          "citation": "O'Sullivan JW, et al. Prevalence and outcomes of incidental imaging findings: potentially serious incidental findings on brain and body magnetic resonance imaging of apparently asymptomatic adults. BMJ. 2018;361:k2387.",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249611/"
        },
        {
          "citation": "Whole-body MRI for opportunistic cancer detection in asymptomatic individuals: a systematic review and meta-analysis. 2025.",
          "url": "https://www.researchgate.net/publication/395107106_Whole-body_MRI_for_opportunistic_cancer_detection_in_asymptomatic_individuals_a_systematic_review_and_meta-analysis"
        },
        {
          "citation": "Fred Hutchinson Cancer Center. Whole-body MRI and cancer screening. August 2025.",
          "url": "https://www.fredhutch.org/en/news/blog/2025/08/whole-body-mri-and-cancer-screening.html"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. Programme comparison: Core, Evolve and Ultimate.",
          "url": "https://years.co/en"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. “Radical transparency: the questions other providers would rather not answer”, homepage section (English and German editions).",
          "url": "https://years.co/de"
        }
      ]
    },
    {
      "subject": "Continuous glucose monitoring",
      "grade": "C",
      "headline": "Continuous glucose monitors for people without diabetes: one trial with an outcome",
      "url": "https://www.baseline-media.com/articles/cgm-in-non-diabetics/",
      "keyFindings": [
        "A systematic review of CGM in non-diabetic individuals for cardiovascular prevention, covering January 2020 to August 2025, found seven eligible studies. Six carried a low risk of bias. Only one dealt with an actual outcome measure.",
        "The clearest positive result is narrow and useful: timing a walk to begin before the postprandial glucose peak significantly reduced post-meal glucose, insulin and C-peptide.",
        "A 2026 systematic review concluded that CGM's effectiveness for glycaemic parameters, body weight and behavioural outcomes in non-diabetic people remains unclear.",
        "Observational work links higher glycaemic variability to surrogate markers such as blood pressure variability, and detects subclinical dysregulation in menopause and obstructive sleep apnoea. These are associations, not demonstrated benefits of monitoring."
      ],
      "assessed": "2026-08-16",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "Use of continuous glucose monitoring in non-diabetic individuals for cardiovascular prevention: a systematic review of its impact on guiding lifestyle interventions.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12612783/"
        },
        {
          "citation": "Continuous glucose monitoring in non-diabetic populations: a systematic review of observational and interventional studies with meta-analysis. European Journal of Medical Research. 2026.",
          "url": "https://link.springer.com/article/10.1186/s40001-026-03920-0"
        },
        {
          "citation": "The efficacy of using continuous glucose monitoring as a behaviour change tool in populations with and without diabetes: a systematic review and meta-analysis of randomised controlled trials.",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668089/"
        },
        {
          "citation": "Non-invasive continuous glucose monitoring in patients without diabetes: use in cardiovascular prevention, a systematic review.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11722592/"
        },
        {
          "citation": "Beyond diabetes: continuous glucose monitoring as a candidate precision tool for cardiovascular prevention and healthy longevity, a hypothesis-generating narrative review.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13515009/"
        }
      ]
    },
    {
      "subject": "Biological age",
      "grade": "D",
      "headline": "Claim check: “our patients reversed their biological age by six years”",
      "url": "https://www.baseline-media.com/articles/claim-check-biological-age-reversed/",
      "keyFindings": [
        "The claim requires the measurement to be sensitive to real change in one individual. Repeated-measures studies show epigenetic clock estimates move substantially with meals, stress and pollution exposure alone.",
        "No clinic making this claim publishes a within-person confidence interval, which is the single number that would make it checkable.",
        "Regression to the mean produces an apparent improvement in anyone selected for a poor initial result, with no intervention required.",
        "Verdict: unsupported. Not because the intervention did nothing, but because the instrument cannot show whether it did."
      ],
      "assessed": "2026-09-07",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "Biological versus technical reliability of epigenetic clocks and implications for disease prognosis and intervention response. 2025.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13418614/"
        },
        {
          "citation": "Belsky DW, et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. eLife. 2022;11:e73420.",
          "url": "https://elifesciences.org/articles/73420"
        }
      ]
    },
    {
      "subject": "Biological age",
      "grade": "D",
      "headline": "Your biological age result would have been different if you had eaten lunch",
      "url": "https://www.baseline-media.com/articles/biological-age-tests-reliability/",
      "keyFindings": [
        "Repeated measures under ordinary short-term perturbations, including meals, stress and pollution exposure, produced substantial swings in epigenetic age estimates. Most clocks reached only moderate reliability at best.",
        "Technical reproducibility did not predict biological stability. GrimAgeV2 and DunedinPACE, two of the most technically robust clocks available, were among the most biologically fragile.",
        "SystemsAge and principal-component-based clocks were both technically stable and comparatively more biologically reliable. No consumer test makes this distinction visible to the buyer.",
        "The clocks carry real prognostic signal at population level. DunedinPACE is associated with morbidity, disability and mortality, with effect sizes comparable to GrimAge. Population validity and individual usability are separate claims."
      ],
      "assessed": "2026-08-06",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "Biological versus technical reliability of epigenetic clocks and implications for disease prognosis and intervention response. 2025.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13418614/"
        },
        {
          "citation": "Belsky DW, et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. eLife. 2022;11:e73420.",
          "url": "https://elifesciences.org/articles/73420"
        },
        {
          "citation": "From the lab to lifestyle: epigenetic clocks in personalized aging and health. Biogerontology. 2026.",
          "url": "https://link.springer.com/article/10.1007/s10522-026-10447-8"
        },
        {
          "citation": "Faster DunedinPACE is associated with accelerated cognitive aging among older adults in the Framingham Heart Study.",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11710093/"
        },
        {
          "citation": "Epigenetic pace of aging (DunedinPACE) predicts incident metabolic syndrome in the Berlin Aging Study II (BASE-II).",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11691513/"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. Programme pricing and per-tier contents, Ultimate tier.",
          "url": "https://www.years.co/de/was-kostet-ein-longevity-check-up"
        },
        {
          "citation": "YEARS Präventivmedizin, Berlin. “Radical transparency: the questions other providers would rather not answer”, homepage section (English and German editions).",
          "url": "https://years.co/en"
        }
      ]
    },
    {
      "subject": "Microbiome testing",
      "grade": "D",
      "headline": "Send the same stool sample to four companies and you get four different microbiomes",
      "url": "https://www.baseline-media.com/articles/microbiome-testing-evidence/",
      "keyFindings": [
        "In a 2026 analytical evaluation of direct-to-consumer gut microbiome services, variability between providers analysing the same material was on the same scale as the biological variability between different donors.",
        "One company returned a replicate in which more than 50% of sequencing reads were unidentified, and still issued a consumer report from it.",
        "There are no regulatory-approved clinical microbiome diagnostic tests. An international consensus statement on microbiome testing in clinical practice found the evidence for clinical usefulness scarce.",
        "Clinicians report patients arriving for medical help on the basis of at-home microbiome results, which is the specific harm of selling an unvalidated test with a confident report attached."
      ],
      "assessed": "2026-08-09",
      "verified": "2026-09-07",
      "references": [
        {
          "citation": "Evaluating the analytical performance of direct-to-consumer gut microbiome testing services. Communications Biology. 2026.",
          "url": "https://www.nature.com/articles/s42003-025-09301-3"
        },
        {
          "citation": "Direct-to-consumer microbiome tests prove wide variability. AGA / Gastroenterology news, April 2026.",
          "url": "https://news.gastro.org/issues/2026/april-2026/dtc-microbiome-tests-prove-wide-variability/"
        },
        {
          "citation": "International consensus statement on microbiome testing in clinical practice.",
          "url": "https://pubmed.ncbi.nlm.nih.gov/39647502/"
        },
        {
          "citation": "Navigating microbiome variability: implications for research, diagnostics, and direct-to-consumer testing.",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12018463/"
        },
        {
          "citation": "Is the current regulatory framework for direct-to-consumer microbiome-based tests sufficient to protect consumers from medical, economic, and dignitary harms?",
          "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12728816/"
        }
      ]
    }
  ]
}