Alvaro Nagib A ta lia h
S P M J / R P M 1 1 5 (2 ): 1 3 8 1 , 1 9 9 7
M e d ic a i c o n tro v e rsie s a n d sy ste m a tic re v ie w s:
th e h e a t a n d th e lig h t
T
h e r e a r e m a n y w a y s to p r o v e th a t d o in g a s y s te m a tic r e v ie w in o r d e r to a c q u ir e th e b e s t e v id e n c e to a p p ly to m e d ic a I p r a c tic e is b e tte r th a n c o n tin u in g to p r a c tic e th e o ld - f a s h io n e d w a y o f p r e p a r in g o v e r v ie w s , w ith n o m e th o d s .
A s y s te m a tic r e v ie w im p lie s th e u s e o f r e p r o d u c ib le m e th o d s . I t a I s o im p lie s th e in te n tio n to p r e v e n t b ia s in th e p r o c e s s o f in c I u d in g a n d e x c lu d in g th e c lin ic a I tr ia I s f o r th e s ta tis tic a I s u m m a r y ( m e ta - a n a ly s is ) , to e s ta b lis h c r ite r ia to in c lu d e w e ll- d e s ig n e d a n d w e ll- c o n d u c te d tr ia ls , a n d th e in te n tio n to b e a t th e p u b lic a tio n b ia s p h e n o m e n o n .
B u t im a g in e th a t s o m e o n e , f o r in s ta n c e , is in te r e s te d in th e e f f e c t o f s tr e p to k in a s e o n th e m o r ta I ity r a te a s a c o n s e q u e n c e o f a c u te m y o c a r d ia I in f a r c tio n . T h is w a s th e c a s e f o r L a u e t a I , 1 9 9 2 ( 1 ) . A f te r a c a r e f u I s e a r c h f o r r e le v a n t tr ia I s in th e lite r a tu r e , a n d s u b m ittin g th e tr ia ls th a t w e r e f o u n d to th e a p p lic a tio n o f in c lu s io n a n d e x c lu s io n c r ite r ia d e s c r ib e d in th e p u b lic a tio n , 3 3 tr ia I s w e r e s e le c te d . O f th e s e , f iv e d e s c r ib e d s ig n if ic a n t r e d u c tio n in m o r ta I ity d u e to in f a r c tio n s , b u t 2 8 d id n o te H o w e v e r , th e ty p ic a I o d d s r a tio s h o w e d a s ig n if ic a n t m o r ta lity r a te r e d u c tio n th a t w a s a I r e a d y d e te c ta b le in th t? c u m u I a tiv e o d d s r a tio in th e e a r ly 1 9 7 0 s , a b o u t 2 0 y e a r s b e f o r e , L a u 's s y s te m a tic r e v ie w .
N o w s u p p o s e th a t a g r o u p o f m e d ic a I s tu d e n ts , a r e s e n t to a g o o d I ib r a r y to r e s e a r c h th e s a m e q u e s tio n , a n d h a d e n o u g h s k ills to f in d th e s a m e 3 3 tr ia I s s e I e c te d , u s in g th e c r ite r ia e s ta b lis h e d in th e s y s te m a tic r e v ie w . E a c h o n e m a y , d e p e n d in g o n th e ir p a r tic u la r s k ills a n d d e te r m in a tio n s , c o m e u p w ith 1 ,2 ,3 ,4 ,5 ,6 , u p to 3 3 tr ia I s , in c o m b in a tio n s o f 3 3 tr ia ls 2 b y 2 , 3 3 tr ia I s 3 b y 3 , 3 3 tr ia I s 4 b y 4 , a n d s o o n . A t th e e n d o f th e d a y th e y w o u ld b e f a c e d w ith 8 ,5 8 9 ,9 3 7 ,5 9 2 d if f e r e n t s e ts o f c lin ic a I tr ia ls , a n d o f c o u r s e , a g r e a t p r o b a b iI ity o f d if f e r e n t o p in io n s . T h a t is u s u a lly c a lle d m e d ic a I c o n tr o v e r s y .
T h u s it is m y u n d e r s ta n d in g th a t d o in g s y s te m a tic r e v ie w s is a g o o d w a y o f p r e c I u d in g th e h e a t o f m e d ic a I c o n tr o v e r s ie s , a n d to s h e d m o r e I ig h t o n im p r o v in g th e p r a c tic e o f m e d ic in e .
REFERENCE
1 . L a u J , A n tm a n E M , J im e n e z - S ilv a J , K u p e ln ic k B , M o s te lle r
F , C h a lm e r s T C . C u m u la tiv e m e ta - a n a ly s is o f th e r a p e u tic
tr ia ls f o r m y o c a r d ia l in f a r c tio n . N E n g l J M e d 1 9 9 2 ;
3 2 7 :2 4 8 - 5 4 .
