Summing up evidence: one answer is not always enough

Abstract

Are meta-analyses the brave new world, or are the critics of such combined analyses right to say that the biases inherent in clinical trials make them uncombinable? Negative trials are often unreported, and hence can be missed by meta-analysts. And how much heterogeneity between trials is acceptable? A recent major criticism is that large randomised trials do not always agree with a prior meta-analysis. Neither individual trials nor meta-analyses, reporting as they do on population effects, tell how to treat the individual patient. Here we take a more rounded approach to meta-analyses, arguing that their strengths outweigh their weaknesses, although the latter must not be brushed aside.