BMJ article: The knowledge system underpinning healthcare is not fit for purpose and must change

Please see below. I look forward to your thoughts. The key messages are valid, but I would argue for a different perspective: The knowledge system underpinning healthcare is not fit for purpose and *must be strengthened* (not ‘must change’). The authors point to well-known issues regarding quality of research, failure to publish, publishing bias, and reliability of systematic reviews. They suggest that ‘including only prospectively registered trials in systematic reviews will improve validity and readability’. It seems to me that a review is more likely to be valid if it takes into account all available evidence, and then uses criteria (including registration among many others) to assess the validity of each piece of research in the systematic review process, as is currently the norm.

A further personal comment is that the healthcare knowledge system is about much more than research, publishing of research, and systematic reviews. HIFA uses a simple model for the global healthcare knowledge system, based on the Lancet article 2004 Can we achieve health information for all by 2015?

http://www.hifa2015.org/about/the-strategy-for-achieving-our-goal/

The BMJ have published an article critiquing the current healthcare knowledge system.

The full article can be read here (subscription required or a free 14 day subscription option is available).

http://www.bmj.com/content/350/bmj.h2463

Roberts Ian, Ker Katharine, Edwards Phil, Beecher Deirdre, Manno Daniela, Sydenham Emma et al. The knowledge system underpinning healthcare is not fit for purpose and must change BMJ 2015; 350 :h2463

Correspondence to: Ian Roberts: ian.roberts@lshtm.ac.uk

The authors argue that medical literature is biased and inundated with poor quality trials. The article explains how these problems affect systematic reviews and how they might be overcome.

It identifies problems with systematic reviews, including the bias created by unpublished trials, low quality – single centred trials, and the fact that most meta analysis – even when they cover 15 or more trials – actually only have a small number of overall trial participants.

The key messages identified in the article are:

Because the medical literature is biased, systematic reviews based on it are also biased. Many reviews are out of date and unreadably long

Including only prospectively registered trials in systematic reviews will improve validity and readability

Insisting that authors of doubtful trials provide the original trial data for statistical checking will improve validity

Requiring review authors to specify an estimated information size based on plausible treatment effects will reduce the risk of false positive conclusions and make reviews more reliable

Trial registries should include full protocols and datasets to facilitate the conduct of valid systematic reviews

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

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