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Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions?
meta-analysis
inconsistent results
mechanism
Individual patient data
asymmetry of evidence
EBM+
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.abstract.en | 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. | pl |
dc.affiliation | Wydział Filozoficzny : Interdyscyplinarne Centrum Etyki | pl |
dc.contributor.author | Maziarz, Mariusz - 414069 | pl |
dc.date.accessioned | 2022-04-19T08:01:16Z | |
dc.date.available | 2022-04-19T08:01:16Z | |
dc.date.issued | 2022 | pl |
dc.date.openaccess | 0 | |
dc.description.accesstime | w momencie opublikowania | |
dc.description.physical | 159-167 | pl |
dc.description.version | ostateczna wersja wydawcy | |
dc.description.volume | 91 | pl |
dc.identifier.doi | 10.1016/j.shpsa.2021.11.007 | pl |
dc.identifier.eissn | 1879-2510 | pl |
dc.identifier.issn | 0039-3681 | pl |
dc.identifier.project | 805498 | pl |
dc.identifier.uri | https://ruj.uj.edu.pl/xmlui/handle/item/291089 | |
dc.language | eng | pl |
dc.language.container | eng | pl |
dc.pbn.affiliation | Dziedzina nauk humanistycznych : filozofia | pl |
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.en | meta-analysis | pl |
dc.subject.en | inconsistent results | pl |
dc.subject.en | mechanism | pl |
dc.subject.en | Individual patient data | pl |
dc.subject.en | asymmetry of evidence | pl |
dc.subject.en | EBM+ | pl |
dc.subtype | Article | pl |
dc.title | Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions? | pl |
dc.title.journal | Studies in History and Philosophy of Science | pl |
dc.type | JournalArticle | pl |
dspace.entity.type | Publication |
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