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

  title={The knowledge system underpinning healthcare is not fit for purpose and must change},
  author={Ian Roberts and Katharine Ker and Phil Edwards and Deirdre Beecher and Daniela Manno and E. A. Sydenham},
  journal={BMJ : British Medical Journal},
The medical literature is biased and inundated with poor quality trials. Ian Roberts and colleagues explain how these problems affect systematic reviews and how they might be overcome 

Broken science and the failure of academics—resignation or reaction?

The authors found that only 56 of 467 of the included meta-analyses fulfilled the basic requirements for a systematic review and that less than 1% of these were rated as overall low risk of bias, which is alarming.

Therapeutic bronchoscopy vs. standard of care in acute respiratory failure: a systematic review

We aimed to assess patient‐important benefits and harms of therapeutic bronchoscopy vs. standard of care (no bronchoscopy) in critically ill patients with acute respiratory failure (ARF).

Pitfalls of clinical practice guidelines in the era of broken science: Let's raise the standards.

Clinical practice guidelines have become an instrumental tool to guide clinical practice because of mounting medical costs, availability of a plethora of newly developed expensive devices and technologies, a transformation of healthcare delivery, a changing demographics with rising number of elderly in need of treatment and finally a substantial variation in the quality of care.

Evaluation of the Quality of Perinatal Trials: Making the GRADE

Structured critical appraisal using GRADE methods to assess risk of bias and other threats to the internal and external validity of RCTs and systematic reviews and meta-analyses of their data facilitates transparency and consistency in using evidence to inform policy and practice.

Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review

Degrees of freedom analysis (DOFA) is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment.

Pre‐hospital opioid analgesia for traumatic injuries

The protocol is being withdrawn from the Cochrane Library and the authors do not intend to complete this review.

Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them

If threats to the validity of clinical research are carefully considered and minimised, research results will be more valid and this will benefit patients and heath care systems.

Scandinavian SSAI clinical practice guideline on choice of first‐line vasopressor for patients with acute circulatory failure

The aim of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force for Acute Circulatory Failure was to present clinically relevant, evidence‐based treatment recommendations on this topic.

Cochrane: the unfinished symphony of research synthesis

It is argued that excluding small trials from reviews would release resources for more detailed appraisal of larger trials, and conducting fewer but broader reviews that contain fewer but properly validated trials might better serve patients’ interests.



Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?

Hilda Bastian and colleagues examine the extent to which critical summaries of clinical trials can be used by health professionals and the public.

Doubts over head injury studies

Patients are receiving treatment that may be unsound as investigations by Ian Roberts and colleagues raise questions about whether influential trials of high dose mannitol ever took place

Meta-analyses of hydroxyethyl starch for volume resuscitation.

The take-home message is that meta-analyses that include multiple studies with practically identical results should be viewed with great caution, especially when multiple studies in a meta-analysis come from the same team of investigators and all of them find exactly the same conclusion.

The scandal of poor medical research

The authors need less research, better research, and research done for the right reasons, and researchers who use the wrong techniques, use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions.

Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis.

In critically ill patients requiring acute volume resuscitation, use of hydroxyethyl starch compared with other resuscitation solutions was not associated with a decrease in mortality and clinical use ofHydroxyethyl starch for acuteVolume resuscitation is not warranted due to serious safety concerns.

Underreporting research is scientific misconduct.

An extended use of prospective registration of trials at inception, as well as benefiting clinical research in other ways, could help people to play their respective roles in reducing underreporting of clinical trials.

Dissemination and publication of research findings: an updated review of related biases.

There was convincing evidence that outcome reporting bias exists and has an impact on the pooled summary in systematic reviews, and empirical evidence suggests that published studies tended to report a greater treatment effect than those from the grey literature.