Audit: QRS - Mistletoe to Treat Cancer

Audit conducted on 12/09/2026 04:10 using AI4L / Opus 5

Iterations

Summary

Items	Count
Total	93
Passed	83
Failed	0
N/A	10
Pass Rate	100.00%

• Total = Passed + Failed + N/A
• Pass Rate = Passed / (Passed + Failed) × 100
• N/A items are excluded from the pass rate calculation

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1. General Rules

#	Description	Result	Comments
1.1	Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER.	🟢	Every cell traces to the ER: protocol cells to ER lines 353-367, time-to-effect to line 414, benefits/risks to the ER section headings, gates to lines 297-329, monitoring table to lines 450-458, cadence to line 446, qualitative items to lines 462-467.
1.2	Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing.	🟢	marker_6_target carries the ER’s own hedge “No established universal target; track direction of change against the individual’s own pre-treatment value” verbatim (ER line 455).
1.3	The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”).	🟢	Contraindications keep their absolute framing (e.g. “Pregnancy and lactation”); survival is kept at the ER’s Low tier and the at-a-glance repeats the ER’s “hold only in studies where everyone knew who was treated”.
1.4	The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc.	🟢	Contraindications come only from “Populations who should avoid Mistletoe” (ER 319-329), Key Interactions only from the interaction bullets (ER 297-317); no Benefit-/Risk-Modifying Factor bullet appears in any gate.
1.5	PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact.	🟢	No PMIDs, NCT identifiers, author names or product brand names (Iscador, Helixor, abnobaVISCUM) appear anywhere in the QRS.
1.6	The QRS does not introduce new attributions.	🟢	All ER citations were stripped; no new source, author or organisation is named beyond “Eastern Cooperative Oncology Group”, which is in the ER (line 329).

2. Focus, Tone & Audience

#	Description	Result	Comments
2.1	The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing.	🟢	Measured, two-sided register throughout; British spellings (“stabilisation”, “tumour”, “leukaemia”) carried over from the ER.
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢	Tiered benefits/risks and a quantified monitoring table sit alongside plain-language framing in the at-a-glance.
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢	Descriptive constructions throughout (“evening dosing is avoided”, “Preparations are supplied as graded ampoule series”); no imperatives directed at a patient.
2.4	The QRS avoids language that implies medical or clinical advice	🟢	Gates and monitoring are presented as observed practice and reference values, not as instructions to the reader.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	No occurrence of “recommend”, “advise”, “should” or “must” in the populated spans.
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person pronouns appear anywhere in the document.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Technical terms are limited to named entities that have no lay equivalent; the at-a-glance is jargon-free.
2.8	Information is presented in a concise and very compact manner	🟢	ER rationales, citations and magnitudes are stripped; the ER’s 15 protocol bullets are reduced to 3 cells and the 6 qualitative bullets lose their trailing justifications.
2.9	It DOES NOT address the reader directly	🟢	Confirmed: no “you”/”your” in any span.
2.10	The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review.	🟢	Matches the ER’s stated framing for “a risk-aware adult facing a cancer diagnosis who is willing to add an injected, self-administered, clinic-supervised therapy” (ER line 147).
2.11	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢	A 2-3× weekly self-injection regimen with per-injection temperature and reaction measurement is presented without hedging about burden.
2.12	The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort.	🟢	Dose-escalation series, titration biomarkers and a nine-marker monitoring panel assume a committed reader.
2.13	Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience.	🟢	The at-a-glance foregrounds the displacement risk, the decision that matters most for an adjunct-seeking reader, mirroring the ER Conclusion.
2.14	The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim.	🟢	The string “anti-aging” does not occur in the QRS.
2.15	The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “oral” / “administered orally” not “taken by mouth” / “given by mouth”; “injection” not “shot”; “adverse event” not “bad reaction”). This holds on EVERY surface, including the QRS lede — the stricter plain-language bar (see 2.7) does not license lay phrasing for route of administration. Direct quotes from sources are exempt.	🟢	Route is given as “Subcutaneous”, “Injection into the abdomen, thigh or upper arm” and “Injected mistletoe extract”; no “shot”, “jab” or similar appears.

3. Template Integrity

#	Description	Result	Comments
3.1	The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why”	🟢	A structural diff against [qrs_template] shows every fixed heading, gate head, tier label and column header byte-identical to the template.
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	All 38 template span names are present; the repeatable marker_#_* and qualitative_item_# anchors are expanded to marker_1..9_* and qualitative_item_1..6 as intended.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	The website="evidence_review", website="audit" and website="full_review" spans, the footer disclaimer, the stylesheet block and the template’s own HTML comments are all untouched.

4. Formatting

#	Description	Result	Comments
4.1	When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied”	N/A	No source ER section that feeds the QRS is empty.
4.2	Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label.	🟢	“Standard route and frequency”, “Dose escalation series” and “Best time of day” are the ER’s bold labels verbatim; Key Interaction labels keep the ER label with only the post-dash clause stripped as item 9.4 requires.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	Time-to-effect labels “Symptomatic change”, “Survival endpoints” and “Local skin reaction” are all phrases taken from ER line 414; the nine marker names match the ER Biomarker column exactly.
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	Zero emoji characters in the file; the ER’s tier emoji and “⚠️ Conflicted” markers were dropped.
4.5	The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page.	🟢	Every section is condensed rather than extended: rationales, citations and magnitudes stripped from gates, benefits and risks; the ER’s 15 protocol bullets reduced to 3 cells. Remaining volume is driven by the completeness mandates in items 8.2, 9.2, 14.2 and 15.2.

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5. Metadata

#	Description	Result	Comments
5.1	The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content.	🟢	Lines 2-14: a single comment opening immediately after <!doctype html> on line 1.
5.2	Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML.	🟢	Line 3 opens and line 13 closes the block; the descriptive text on line 2 precedes the opening delimiter.
5.3	The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet.	🟢	Enclosed in an HTML comment; no metadata value is echoed into the body except the model name and date the template itself requires in the subline.
5.4	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Only duration: "00:03" is quoted, and it contains a colon; all other values are bare and trimmed.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢	Line 4: er_filename: mistletoe_cancer_2026-0912-0002_Opus_ER.md.
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	Line 5: qrs_prompt_version: 26.9.11, matching the version badge in QRS.md.
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	Line 6: qrs_creation_date: 2026-0912-0403.
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢	Line 7: qrs_creator_ai_nickname: Opus.
5.9	The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT)	🟢	“Opus” is a single word with no version or qualifier.
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢	Line 8: qrs_creator_ai_fullname: Opus 5.
5.11	The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4)	🟢	“Opus 5” is nickname plus version with no context-window or other qualifier appended.
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢	Line 9 matches the file on disk: mistletoe_cancer_2026-0912-0002_Opus_QRS.html.
5.13	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Re-checked across all nine keys including git_user and git_issue; all clean.

6. Page Title & Header

#	Description	Result	Comments
6.1	[page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &)	🟢	Line 22: “Mistletoe to Treat Cancer - Quick Reference Sheet”; the ER canonical_topic is “Mistletoe to Treat Cancer” and contains no characters needing encoding.
6.2	[header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &)	🟢	Line 417: “Mistletoe to Treat Cancer”.
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	Line 421: “09/12/2026”, the correct MM/DD/YYYY rendering of 2026-0912.
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	Line 425: “Opus 5”, matching the frontmatter value.
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢	The header holds only the title and the template subline; the ER’s long “Also known as” list was not carried over.

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] is dense, execution-oriented summary of the ER Conclusion section	🟢	Compresses all three Conclusion paragraphs into four sentences and closes on the decision that matters, the displacement risk.
7.2	[at_a_glance] is no longer than 60 words	🟢	59 words.
7.3	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢	Each clause maps to a distinct Conclusion sentence (ER lines 489-491), including “near-universal” ← “Almost everyone develops a skin reaction at the injection site”.
7.4	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	No acronyms; the most technical word is “chemotherapy”, which a non-specialist uses unprompted.
7.5	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢	No trial name, year, sample size or p-value appears.
7.6	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢	No hazard ratio, standardised mean difference or confidence interval appears.

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	All nine items come from the “Populations who should avoid Mistletoe” list at ER lines 319-329.
8.2	[stop_items] represent the Contraindications from the ER	🟢	All nine ER entries are present, in ER order, with none added.
8.3	Individual [stop_items] are formatted as <li></li>	🟢	Lines 553-566: nine well-formed <li> elements inside the span.
8.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	Trailing rationales stripped throughout: “where further inflammatory swelling could force brain tissue out of position”, “because of graft-rejection risk”, “where mistletoe’s toxic constituents make exposure unacceptable” and the drug-monograph attribution on leukaemia/lymphoma.
8.5	Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Preserved: “above 38 °C … until resolved”, “resting heart rate above 100 beats per minute”, “performance status 4 (completely bedbound)” trimmed from the ER’s longer gloss.
8.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER uses no ranking notation inside parentheses in this list.
8.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision.	🟢	The ER names nine such populations and the section is correctly populated rather than empty.
8.8	If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The section is not empty.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	All eleven items come from the interaction bullets at ER lines 297-317.
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	All eleven ER interaction bullets are carried across in ER order; none duplicates a contraindication entry.
9.3	Individual [caution_items] are formatted as <li></li>	🟢	Lines 574-586: eleven well-formed <li> elements inside the span.
9.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	Every “- caution, …” / “- monitor, …” clause and every mitigation sentence is stripped; the PET entry drops the “which image tissue metabolic activity” gloss.
9.5	Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	All nine ER example-drug lists are preserved intact, e.g. “(pembrolizumab, nivolumab, ipilimumab, atezolizumab)” and “(hawthorn, garlic, hibiscus)”.
9.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER uses no ranking notation inside parentheses in this list.
9.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used.	🟢	The ER names eleven such interactions and the section is correctly populated rather than empty.
9.8	If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The section is not empty.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Protocol section	🟢	All three cells trace to the ER Therapeutic Protocol bullets at lines 353, 355 and 367.
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section	🟢	Route/frequency, dose-escalation range and timing of administration are the three bullets a reader must act on; the remaining bullets are product selection, background or non-actionable.
10.3	If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER contains far more than three actionable aspects; all three sets are used.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section.	🟢	All nine spans carry ER-derived content; no placeholder text remains.

11. Time to Effect

#	Description	Result	Comments
11.1	The three sets of [time] items cover the three most important time-to-effect aspects from the ER	🟢	The ER’s “Time to effect” bullet (line 414) names exactly three horizons and all three are carried across.
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Symptomatic change first (High-tier quality-of-life and fatigue benefits), survival second (Low tier), local skin reaction last (a titration signal, not a benefit).
11.3	If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	Three distinct aspects are present in the ER; all three sets are used.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢	All nine spans are populated from ER line 414 with no placeholder text.
11.5	If the ER does not provide any information on time to effect, the section is removed completely from the Protocol Panel	N/A	The ER does provide time-to-effect information.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢	All eight entries map to the ER’s H4 benefit headings at lines 151-201.
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢	All four spans present and populated at lines 529-543, matching the ER’s 2/1/4/1 tier distribution.
12.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Each entry is the ER heading alone; all Magnitude lines, prose and “⚠️ Conflicted” qualifiers are dropped.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheses appear in any benefits span.
12.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four benefit tiers contain items in the ER.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢	All nine entries map to the ER’s H4 risk headings at lines 225-279.
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢	All four spans present and populated at lines 598-614, matching the ER’s 2/2/3/2 tier distribution.
13.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Each entry is the ER heading alone; frequencies such as “66% versus 1% on placebo” and “14.8% (3 of 21)” are dropped.
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheses appear in any risks span; “grade 3 or higher” is retained as part of the ER heading itself, not as a parenthetical.
13.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four risk tiers contain items in the ER.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring section	🟢	The table reproduces the ER Monitoring Protocol & Defining Success biomarker table (ER lines 448-458).
14.2	All measurable/quantifiable biomarkers from the Monitoring section are listed	🟢	All nine ER rows are present in ER order: body temperature, local reaction diameter, full blood count, C-reactive protein, liver enzymes, tumour markers, albumin, thyroid-stimulating hormone, body weight.
14.3	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty.	🟢	Lines 748-751 reproduce every interval from ER line 446, with only “aligned with oncology review” trimmed.

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring section	🟢	All six items come from the “Qualitative markers worth tracking” list at ER lines 462-467.
15.2	All subjective/qualitative biomarkers from the Monitoring section are listed	🟢	All six ER entries are present in order, with their trailing justifications and citation stripped.

Issues 12/09/2026 04:10

Pass rate 100.00%. No issues found.