ecbzkvgxsamjos8CITATION: Richard Horton. Offline: The gravy train of systematic reviews
The Lancet Comment| volume 394, issue 10211, p1790, november 16, 2019
Published: November 16, 2019

Imagine if the entire edifice of knowledge in medicine was built upon a falsehood. Systematic reviews are said to be the highest standard of evidence-based health care. Regularly updated to ensure that treatment decisions are built on the most up-to-date and reliable science, systematic reviews and meta-analyses are widely used to inform clinical guidelines and decision making… But what if the astonishing energy, commitment, and productivity of the systematic review community are poisoning rather than nourishing medical practice? This question has been repeatedly asked by one of the UK’s leading clinical trialists, Ian Roberts, Professor of Epidemiology and Public Health and Co-Director of the Clinical Trials Unit at the London School of Hygiene & Tropical Medicine…

Ian Roberts… speaks about “the extreme unreliability of most systematic reviews”. Selection bias and the inclusion of fraudulent “randomised trials” mean that meta-analyses of small trials will too often “get the wrong answer”…

Comment (Neil PW): Ian Roberts’ criticism is not levelled at the concept of systematic reviews, but at how they are done. The charge is that sub-standard research is not filtered out, thereby polluting the findings. It would be interesting to hear the views of Cochrane members and others.

Best wishes, Neil

Coordinator, HIFA Project on Evidence-Informed Policy and Practice