Miles O'Brien
What Are the Levels
Four ladders, each read from the bottom up. Every page has two orders.
What works most ranks by how well a step works: the size of the effect in the research. The smallest effect sits at the bottom. The largest sits at the top. A meta-analysis and a single case can land on any rung. The badge on the card tells you which is which. It does not set the position.
Miles's order is the list he actually uses, in his words, with nothing dropped and nothing reordered. Where the two lists disagree, the page says so.
Not medical advice. This site sums up published research and Miles O'Brien's own notes. It does not replace a clinician who knows you. Never stop or change bipolar medication without your prescriber.
- 01
Bipolar
Ranked by the size of the reported effect. Lithium is at the top: mania SMD −0.37, relapse RR 0.65, suicide OR 0.13. Stem cells, with no bipolar outcome, are at the bottom. Evidence strength is a badge.
- 02
Congestion
A blocked nose in adults. Ranked by the size of the reported effect, from oral phenylephrine, which did not beat placebo, up to septoplasty’s quality-of-life gain when the septum is deviated. Evidence strength is a badge.
- 03
Losing weight
Ranked by weight lost versus a comparison group, smallest at the bottom. Exercise alone is the smallest. Gastric bypass, about −27% at 3 years, is the largest. Evidence strength is a badge.
- 04
Getting closer to God
Miles's ladder stays the default, from ignoring God to surrendering. What works most ranks practices by the size of the measured change in health or spiritual well-being. Science cannot measure closeness to God directly. The framing is Christian, because he reads the Bible.