Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions?

2022
journal article
article
14
dc.abstract.enLiterature-based meta-analysis is a standard technique applied to pool results of individual studies used in medicine and social sciences. It has been criticized for being too malleable to constrain results, averaging incomparable values, lacking a measure of evidence's strength, and problems with a systematic bias of individual studies. We argue against using literature-based meta-analysis of RCTs to assess treatment efficacy and show that therapeutic decisions based on meta-analytic average are not optimal given the full scope of existing evidence. The argument proceeds with discussing examples and analyzing the properties of some standard meta-analytic techniques. First, we demonstrate that meta-analysis can lead to reporting statistically significant results despite the treatment's limited efficacy. Second, we show that meta-analytic confidence intervals are too narrow compared to the variability of treatment outcomes reported by individual studies. Third, we argue that literature-based meta-analysis is not a reliable measurement instrument. Finally, we show that meta-analysis averages out the differences among studies and leads to a loss of information. Despite these problems, literature-based meta-analysis is useful for the assessment of harms. We support two alternative approaches to evidence amalgamation: meta-analysis of individual patient data (IPD) and qualitative review employing mechanistic evidence.pl
dc.affiliationWydział Filozoficzny : Interdyscyplinarne Centrum Etykipl
dc.contributor.authorMaziarz, Mariusz - 414069 pl
dc.date.accessioned2022-04-19T08:01:16Z
dc.date.available2022-04-19T08:01:16Z
dc.date.issued2022pl
dc.date.openaccess0
dc.description.accesstimew momencie opublikowania
dc.description.physical159-167pl
dc.description.versionostateczna wersja wydawcy
dc.description.volume91pl
dc.identifier.doi10.1016/j.shpsa.2021.11.007pl
dc.identifier.eissn1879-2510pl
dc.identifier.issn0039-3681pl
dc.identifier.project805498pl
dc.identifier.urihttps://ruj.uj.edu.pl/xmlui/handle/item/291089
dc.languageengpl
dc.language.containerengpl
dc.pbn.affiliationDziedzina nauk humanistycznych : filozofiapl
dc.rightsUdzielam licencji. Uznanie autorstwa 4.0 Międzynarodowa*
dc.rights.licenceCC-BY
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/legalcode.pl*
dc.share.typeotwarte czasopismo
dc.subject.enmeta-analysispl
dc.subject.eninconsistent resultspl
dc.subject.enmechanismpl
dc.subject.enIndividual patient datapl
dc.subject.enasymmetry of evidencepl
dc.subject.enEBM+pl
dc.subtypeArticlepl
dc.titleIs meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions?pl
dc.title.journalStudies in History and Philosophy of Sciencepl
dc.typeJournalArticlepl
dspace.entity.typePublication
dc.abstract.enpl
Literature-based meta-analysis is a standard technique applied to pool results of individual studies used in medicine and social sciences. It has been criticized for being too malleable to constrain results, averaging incomparable values, lacking a measure of evidence's strength, and problems with a systematic bias of individual studies. We argue against using literature-based meta-analysis of RCTs to assess treatment efficacy and show that therapeutic decisions based on meta-analytic average are not optimal given the full scope of existing evidence. The argument proceeds with discussing examples and analyzing the properties of some standard meta-analytic techniques. First, we demonstrate that meta-analysis can lead to reporting statistically significant results despite the treatment's limited efficacy. Second, we show that meta-analytic confidence intervals are too narrow compared to the variability of treatment outcomes reported by individual studies. Third, we argue that literature-based meta-analysis is not a reliable measurement instrument. Finally, we show that meta-analysis averages out the differences among studies and leads to a loss of information. Despite these problems, literature-based meta-analysis is useful for the assessment of harms. We support two alternative approaches to evidence amalgamation: meta-analysis of individual patient data (IPD) and qualitative review employing mechanistic evidence.
dc.affiliationpl
Wydział Filozoficzny : Interdyscyplinarne Centrum Etyki
dc.contributor.authorpl
Maziarz, Mariusz - 414069
dc.date.accessioned
2022-04-19T08:01:16Z
dc.date.available
2022-04-19T08:01:16Z
dc.date.issuedpl
2022
dc.date.openaccess
0
dc.description.accesstime
w momencie opublikowania
dc.description.physicalpl
159-167
dc.description.version
ostateczna wersja wydawcy
dc.description.volumepl
91
dc.identifier.doipl
10.1016/j.shpsa.2021.11.007
dc.identifier.eissnpl
1879-2510
dc.identifier.issnpl
0039-3681
dc.identifier.projectpl
805498
dc.identifier.uri
https://ruj.uj.edu.pl/xmlui/handle/item/291089
dc.languagepl
eng
dc.language.containerpl
eng
dc.pbn.affiliationpl
Dziedzina nauk humanistycznych : filozofia
dc.rights*
Udzielam licencji. Uznanie autorstwa 4.0 Międzynarodowa
dc.rights.licence
CC-BY
dc.rights.uri*
http://creativecommons.org/licenses/by/4.0/legalcode.pl
dc.share.type
otwarte czasopismo
dc.subject.enpl
meta-analysis
dc.subject.enpl
inconsistent results
dc.subject.enpl
mechanism
dc.subject.enpl
Individual patient data
dc.subject.enpl
asymmetry of evidence
dc.subject.enpl
EBM+
dc.subtypepl
Article
dc.titlepl
Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions?
dc.title.journalpl
Studies in History and Philosophy of Science
dc.typepl
JournalArticle
dspace.entity.type
Publication
Affiliations

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