Systematic reviews do not (yet) represent the ‘gold standard’ of evidence: a position paper

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The low quality of included trials, insufficient rigour in review methodology, ignorance of key pain issues, small size, and over-optimistic judgements about the direction and magnitude of treatment effects all devalue systematic reviews, supposedly the ‘gold standard’ of evidence. Available evidence indicates that almost all systematic reviews in the published literature contain fatal flaws likely to make their conclusions incorrect and misleading. Only 3 in every 100 systematic reviews are deemed to have adequate methods and be clinically useful. Examples of research waste and questionable ethical standards abound: most trials have little hope of providing useful results, and systematic review of hopeless trials inspires no confidence. We argue that results of most systematic reviews should be dismissed. Forensically critical systematic reviews are essential tools to improve the quality of trials and should be encouraged and protected.
Original languageEnglish
Pages (from-to)557-566
Number of pages10
JournalEuropean Journal of Pain
Issue number3
Early online date8 Jan 2022
Publication statusPublished - 31 Mar 2022

Bibliographical note

Funding Information:
No funding was received for this work. The authors are grateful to Professor Luis Garcia-Larrea for his guidance in the development of the manuscript, and to Professor David Gavaghan for help with simulations.


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