Audit: QRS - PDE5 Inhibitors for Health & Longevity

Audit conducted on 25/09/2026 19:28 using AI4L / Opus 5.5

Iterations

Summary

Items	Count
Total	94
Passed	84
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.	🟢	All lede, protocol, gate, tier, marker and cadence content traced to ER passages (Conclusion, Therapeutic Protocol, Practical Considerations, Key Interactions & Contraindications, Monitoring table).
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.	🟢	ER hedges carried over: “size unknown” (ER “any true effect is of unknown size”), “plausible but unproven”, “If real, would accrue”.
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”).	🟢	No claim strengthened or softened; contraindications mirror the ER “Populations who should avoid” list and “not recommended” for vericiguat is kept.
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 from the ER avoid list, cautions from the interaction bullets, risks from Potential Risks; no modifying factor relabeled.
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, citations, expert names, NCT IDs or brand names appear.
1.6	The QRS does not introduce new attributions.	🟢

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.	🟢
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢
2.4	The QRS avoids language that implies medical or clinical advice	🟢	Protocol and cadence stated descriptively (“Labeled regimen”, “immediate evaluation for sudden vision or hearing change”).
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person address found.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Class names in gates are kept with named example drugs; NAION is glossed (“sudden optic-nerve vision loss”).
2.8	Information is presented in a concise and very compact manner	🟢	Contraindications merged from 12 ER entries into 10; interactions merged from 18 ER bullets into 12.
2.9	It DOES NOT address the reader directly	🟢
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.	🟢
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.	🟢
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.	🟢
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.	🟢	Lede closes on the audience-specific framing: daily use against blood-vessel aging is plausible but unproven.
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.	🟢	No “anti-aging” wording.
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.	🟢	Lede uses “prescription oral medications”; no lay route-of-administration phrasing.

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”	🟢	All fixed headings, gate heads, tier labels and column headers match the template.
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	Source diff against the template: all 34 template spans present; marker_# and qualitative_item_# expanded to numbered spans.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	Diff shows only variable span contents changed.

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 ER section feeding 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.	🟢	Protocol labels “Daily low-dose tadalafil”, “On-demand sildenafil”, “On-demand tadalafil” are the ER bold labels verbatim.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	No emoji present.
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.	🟢	Gate and interaction lists condensed by merging related ER entries.

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.	🟢	Metadata comment is line 2, directly after <!doctype html>.
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.	🟢
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.	🟢
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 is quoted (“00:00”), which contains a colon.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	26.9.25 matches QRS.md version.
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	2026-0925-1900
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢
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
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢
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 5.5
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢
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.	🟢

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 &)	🟢	“PDE5 Inhibitors for Health & Longevity - Quick Reference Sheet”
6.2	[header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &)	🟢
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	09/25/2026
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	Opus 5.5
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] opens by saying what the intervention is — its kind (e.g., dietary supplement, prescription medication, peptide, plant, procedure, practice) — and what it is used for, in plain language, before any verdict on the evidence	🟢	Opens “These prescription oral medications, best known for erectile problems, relax blood vessels.”
7.2	[at_a_glance] is dense, execution-oriented summary of the ER Conclusion section	🟢
7.3	[at_a_glance] is no longer than 70 words	🟢	70 words (script count).
7.4	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢
7.5	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢
7.6	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢
7.7	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER Key Interactions & Contraindications section	🟢
8.2	[stop_items] represent the Contraindications from the ER	🟢	All 12 ER avoid-list populations covered in 10 items.
8.3	Individual [stop_items] are formatted as <li></li>	🟢
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.	🟢	No trailing clauses or rationale; only qualifiers and a plain-language gloss for NAION.
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).	🟢	Nitrate time windows, 90/50 and 170/110 mmHg thresholds, 6-month window, NYHA III–IV, Child-Pugh C and 30 mL/min threshold preserved.
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	ER uses no ranking notation.
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.	🟢	Section populated; ER names populations to avoid.
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	Section is not empty.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	All non-contraindicated ER interactions covered; riociguat, nitrates and poppers kept only in Contraindications.
9.3	Individual [caution_items] are formatted as <li></li>	🟢
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.	🟢
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).	🟢	Example drug lists kept in trimmed form; “not recommended” severity kept for vericiguat.
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	ER uses no ranking notation.
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.	🟢	Section populated; ER names interactions.
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	Section is not empty.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Protocol section	🟢
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section	🟢	First three ER Therapeutic Protocol regimens used.
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	ER provides more than three actionable aspects.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section.	🟢

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	🟢	On-demand erectile onset, urinary benefit of daily tadalafil and vascular timescale from ER Practical Considerations.
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Erections (High, first-listed) then urinary relief (High) then vascular effects.
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	ER provides at least three time-to-effect aspects.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢
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	ER provides time-to-effect information.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢
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.	🟢
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheticals in benefit items.
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 have items.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢
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.	🟢
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheticals in risk items.
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 have items.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring section	🟢
14.2	All measurable/quantifiable biomarkers from the Monitoring section are listed	🟢	All 10 rows of the ER Monitoring table listed.
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.	🟢

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring section	🟢
15.2	All subjective/qualitative biomarkers from the Monitoring section are listed	🟢	All 7 ER qualitative markers listed.

Issues 25/09/2026 19:28

Pass rate 100.00%. No issues found.

Issues 25/09/2026 19:24

1. 2.7 — Unnecessary jargon in cards: Risks and Benefits use clinical terms where the ER supplies plain equivalents: “Dyspepsia and reflux” and “symptomatic hypotension” (risks_high, line 583), “priapism” (risks_low, line 589) and “pulmonary arterial hypertension” (benefits_high, line 522).

Fixes 25/09/2026 19:24

1. 2.7 — Replaced jargon with ER plain terms: Changed “pulmonary arterial hypertension” to “high blood pressure in the lung arteries” (benefits_high), “dyspepsia” to “indigestion” and “symptomatic hypotension” to “blood-pressure drop” (risks_high), and “priapism” to “prolonged erection” (risks_low), using the ER’s own glosses.

Issues 25/09/2026 19:20

1. 2.7 — Unnecessary jargon in risks: The Risk & Side Effects card uses “Sudden sensorineural hearing loss” (line 586) and “Nonarteritic anterior ischemic optic neuropathy” (line 589) although the ER supplies plain equivalents (“Sudden hearing loss”, “sudden, painless vision loss from reduced optic-nerve blood flow”).

Fixes 25/09/2026 19:20

1. 2.7 — Plain-language risk labels: Replaced “Sudden sensorineural hearing loss” with “Sudden hearing loss” and “Nonarteritic anterior ischemic optic neuropathy” with “Sudden optic-nerve vision loss” in the Risk & Side Effects card, using the ER’s own plain wording.

Issues 25/09/2026 19:16

1. 7.2 — Lede omits audience bottom line: The at-a-glance text (QRS line 433) covers only the first two paragraphs of the ER Conclusion and leaves out the execution-oriented verdict for this audience (ER line 501: daily low-dose use is “a plausible but unproven tool against blood-vessel aging”).

Fixes 25/09/2026 19:16

1. 7.2 — Lede omits audience bottom line: Added the ER Conclusion verdict “Daily use against blood-vessel aging is plausible but unproven.” to the at-a-glance text, and tightened wording (dropped the drug-name aside, “Health-record studies” to “Health records”) to stay within 70 words.

Issues 25/09/2026 19:12

1. 1.1 — Skin examination condition garbled: Monitoring cadence (line 723) says “annual skin examination with melanoma risk factors”, whereas the ER restricts the annual skin examination to “those with melanoma risk factors”.
2. 2.15 — Lay phrasing in lede: The at-a-glance lede (line 433) uses “erection problems” instead of the ER’s clinical wording “erectile problems”.
3. 4.2 — ER bold label dropped: Key Interactions item “Vericiguat (not recommended)” (line 559) omits the ER bold label “Soluble guanylate cyclase stimulators”.

Fixes 25/09/2026 19:12

1. 1.1 — Skin examination condition restored: Changed monitoring cadence from “annual skin examination with melanoma risk factors” to “annual skin examination for those with melanoma risk factors”, matching the ER.
2. 2.15 — Clinical wording in lede: Replaced “erection problems” with the ER’s “erectile problems” in the at-a-glance lede.
3. 4.2 — ER bold label restored: Changed “Vericiguat (not recommended)” to “Soluble guanylate cyclase stimulators (vericiguat; not recommended)”.

Issues 25/09/2026 19:09

1. 4.5 — Sheet exceeds one A4 page: The Contraindications (14 items) and Key Interactions (16 items) gates, lines 541-579, plus 10 monitoring rows and 7 qualitative items, render well beyond one A4 page; gate and qualitative lists were not condensed to the one-page budget.

Fixes 25/09/2026 19:09

1. 4.5 — Condensed gates for one page: Merged related Contraindications (14 to 10 items) and Key Interactions (16 to 12 items), trimming example-drug lists while keeping every qualifier, and shortened the monitoring cadence text to reduce the sheet toward the one-page A4 budget.

Issues 25/09/2026 19:05

1. 2.7 — Unexplained acronyms on sheet: “BPH” in action_1_sub (line 450), “NAION” in the Contraindications gate (line 553; never tied to the spelled-out risk on line 597) and “ED” in marker_2_why (line 636) are left unexpanded although plain-language equivalents exist in the ER.

Fixes 25/09/2026 19:05

1. 2.7 — Unexplained acronyms expanded: Replaced “BPH” in action_1_sub with “enlarged-prostate urinary symptoms”, expanded “Prior NAION in either eye” to “Prior nonarteritic anterior ischemic optic neuropathy (NAION, sudden optic-nerve vision loss) in either eye”, and changed marker_2_why from “Atherosclerosis driving ED” to “Atherosclerosis driving erectile dysfunction”.

Issues 25/09/2026 19:03

1. 1.3 — Skin-exam condition blurred: The monitoring cadence (QRS line 729) reads “annual skin examination with melanoma risk factors”, dropping the ER’s conditional “for those with melanoma risk factors” (ER line 457).
2. 8.5 — Nitrate contraindication qualifiers dropped: Stop item 1 (QRS line 542) omits the ER’s named nitrate/NO-donor agents (incl. nicorandil), the 24-hour/48-hour nitrate window, and the “poppers”/amyl nitrite examples (ER lines 339, 350).

Fixes 25/09/2026 19:03

1. 1.3 — Skin-exam condition restored: Changed the cadence text from “annual skin examination with melanoma risk factors” to “annual skin examination for those with melanoma risk factors”, matching ER line 457.
2. 8.5 — Nitrate contraindication qualifiers restored: Replaced “People using any organic nitrate or nitrite inhalant, or riociguat” with three items: organic nitrates and nitric oxide donors (named agents plus the 24-hour/48-hour window), alkyl nitrite inhalants (“poppers”, amyl nitrite), and riociguat.