(1) meta-analyses are often “overpowered” with clinically irrelevant results that might emerge as highly significant;

(2) there is serious concern of publication biases with “negative” studies not being published;

(3) meta-analyses consider the variation in the results of the empirical studies included to be random noise, however, the variability of results across studies can be informative;

(4) the result of a meta-analysis depends on the strategy used to identify the included empirical studies;

(5) the quality of conclusions from meta-analyses depends on the statistical tests used to combine the results of the separate studies;

(6) the qualitative conclusions drawn from the meta-analytical combination of individual studies may depend on specific design aspects of the individual studies.

Thus, meta-analyses are primarily a method to generate hypotheses through an a posteriori analysis of treatment effects. ^[1]

En ze eindigen met de duidelijke vingerwijzing dat we meta-analyses niet te lichtvaardig moeten zien als de basis voor de klinische praktijk!!!

In any case, the emphasis on meta-analyses oversimplify the complexity of individual informative studies. This is also true if conclusions from meta-analyses are transferred to clinical practice. 

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Erik - meer en eerdere wantrouwen 12-03-2010 22:08:32 Er was (als voorbeeldje) ook al in 2007 wantrouwen over de meta-analyse voor EBM. Zie PubMed: http://www.ncbi.nlm.nih.gov/pubmed/17687536?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed