Reducing systematic review to a cut and paste.
Reducing systematic review to a cut and paste.
复制标题
将系统审查减少为剪切和粘贴。
DOI：
10.1159/000322397
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Vickers,AndrewJ
中科院分区：
文献类型：
--
作者：
Vickers,AndrewJ
我第一次参与系统评价时，它仍然相对有争议。我记得有人认为，综述不可避免地会导致"把苹果和橘子联合收割机结合起来“;我还记得在镁治疗心肌梗死的随机试验未能证实荟萃分析的有希望的结果后，我谈到了”系统综述的终结“。这两个论点都经不起时间的考验。但我也记得有人说，系统性综述允许研究人员对已发表的试验进行无意义的重新分析，以取代更苛刻的、科学上更有成效的收集新数据的工作。当时我认为这是一个相当愚蠢的观点。结果证明我错了。多年来，我一直试图跟上最新的针灸系统评价，特别是关于我的工作针灸试验者合作[1，2]。人们不能不注意到，许多针灸评论关注的是相当狭窄的适应症，而不是当代临床实践的重要组成部分。例如，在我看到系统综述之前，我从未听说过针灸是治疗精神分裂症的一种方法[3]。同样，我第一次意识到艾灸可以用来治疗化疗恶心是通过阅读这篇评论[4]，也许奇怪的是，我在一家癌症医院工作，并对针灸治疗癌症相关症状进行了研究。即使是最粗略的阅读评论摘要也会跳出来的是，结论几乎是相同的。文本框1给出了几篇针灸系统综述摘要的结论。几乎在每一个案件中，证据都被描述为“不可靠”、“有限”或“不令人信服”。然后，作者通常要求“进一步研究”或“严格设计的试验”。仔细阅读这些论文本身会让似曾相识的感觉加倍：文本框2引用了一些评论的研究方法。这是一种惊人的一致性，好像系统性的评论只不过是把面糊放进蛋糕模具里，然后让烤箱发挥作用。在我个人看来，这些评论是空洞的科学练习，没有教会我们任何东西。例如，有人真的相信有令人信服的数据支持针灸缓解前列腺癌患者的潮热吗？如果没有，当一个评论家告诉我们“证据不令人信服”时，我们学到了什么？此外，那些要求“进一步研究”的呼吁又如何呢？这些是对研究重点的仔细分析，还是只是简单的剪切和粘贴？评论者是否认真考虑进行一项随机试验，比如说，艾灸治疗高血压？如果没有，他们认为他们的评论以什么方式帮助了其他研究人员？这里引用的系统评价证实了那些早期系统评价批评者的预测：它们使评论者显得在科学上富有成效，但它们对促进科学发展或帮助减轻人类痛苦几乎没有帮助。
I first became involved in systematic review when it was still relatively controversial. I remember it being argued that reviews inevitably led one to ‘combine apples and oranges’; I also remember talk about ‘the end of systematic review’after a randomized trial of magnesium for myocardial infarct failed to confirm promising results from a meta-analysis. Neither of these arguments has stood the test of time. But I also remember it being said that systematic review allowed investigators to pump out meaningless re-analyses of published trials in place of the more demanding, and scientifically productive, work of collecting new data. At the time I thought that this was a rather silly point. It turns out that I was wrong. Over the years, I have tried to keep abreast of the latest systematic reviews on acupuncture, particularly with respect to my work for the Acupuncture Trialists’ Collaboration [1, 2]. One cannot help but notice that many acupuncture reviews concern rather narrow indications that are not an important component of contemporary clinical practice. For example, until I saw the systematic review, I had never heard of acupuncture being a treatment for schizophrenia [3]. Similarly, I was first made aware that moxibustion could be used to treat chemotherapy nausea by reading the review [4], perhaps odd given that I work in a cancer hospital and have conducted research on acupuncture for cancer-related symptoms. What also leaps out from even the most cursory reading of the review abstracts is that the conclusions are almost identical. Text box 1 gives the conclusions from the abstracts of several acupuncture systematic reviews. In almost every case, the evidence is described as ‘insufficient’,‘limited’or ‘not convincing’. The authors then typically call for ‘further research’or ‘rigorously designed trials’. Careful reading of the papers themselves redoubles the sense of déjà vu: text box 2 cites text from the research methods of some reviews. There is a remarkable consistency, as if systematic review was little more than putting batter in a cake mold and then letting the oven do its work.In my personal opinion, these reviews are empty scientific exercises that teach us nothing. For example, did anyone really believe that there were convincing data in favor of acupuncture relieving hot flashes in men with prostate cancer? If not, what have we learned when a reviewer tells us that ‘the evidence is not convincing’? Moreover, what about those calls for ‘further research’: are these careful analyses of research priorities or simply more cut and paste? Were the reviewers seriously considering conducting a randomized trial on, say, moxibustion for hypertension? If not, in what way do they believe that their review has helped other researchers? The systematic reviews cited here confirm the predictions of those early critics of systematic review: they make the reviewer appear scientifically productive, but they do little to further science, or help relieve human suffering.