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"The Trouble With Evidence-Based Medicine, the 'Brand'" By Hilda Bastian (July 12)


Senior Member
One issues I can see with meta-analyses and systematic reviews is quite often they are done by people from the field who have a reasonably good idea what the evidence is already.

They can then focus on outcome measures for their favourite interventions that they know came out well (or alternatively on outcome measures that don't suit interventions they don't favour).

So in the ME/CFS, CBT and GET meta-analyses might focus on fatigue scores and (self-reported) physical functioning and these results can look impressive but if other outcome measures are looked at, the evidence isn't so impressive.


Senior Member
Here are some sourses about the downside of meta analysis. I think the following are just some of the important points. The article also talks about John Ioannidis. Bold is mine.

I still like the meta-analysis and systemic reviews as a nice overview of a clinical topic, but, for reasons we will see, I am hesitant to draw any therapeutic conclusions from any meta-analysis

when I see the word study, and I think oh good. Someone has done a clinical trial. Enrolled patients and compared, in a double blind manner, interventions against placebo. No. It is a meta-analysis. Calling a meta-analysis a study is not unlike a library declaring they acquired several dozen new books and magazines when their copy of Readers Digest arrives. Someone massaging preexisting data; hardly a study. Nice for an overview of a topic, but worthless for drawing conclusions definitive conclusions.

When applied to real treatments, those based on reality and known physiology, the results of meta-analysis are often not predictive of well done clinical trials:

The outcomes of the 12 large randomized, controlled trials that we studied were not predicted accurately 35 percent of the time by the meta-analyses published previously on the same topics

I will try and post some other sources but it will have to be tomorrow as I am having one of my worst day of fogginess and don't want to repeat what others have or will be saying. Hope, I haven't done that with this article.

I wonder how much my fog has to do with laughing so hard from a certain thread. Worth it if it was. But who knows? Maybe we should do a meta analysis of how many others had this happen. Oh wait, it won't be valid.:lol: