METAANALYSIS - STATISTICAL ALCHEMY FOR THE 21ST-CENTURY - DISCUSSION - A PLEA FOR A MORE BALANCED VIEW OF METAANALYSIS AND SYSTEMATIC OVERVIEWS OF THE EFFECT OF HEALTH-CARE INTERVENTIONS

The paper discusses some of the most common criticisms to meta-analysis presented by Professor Feinstein in this Conference. As many of the points raised in his contributions are not new, a critique to them is presented in the context of the type of contribution given by systematic reviews (meta-analysis) to the analysis of the effects of health care interventions. After discussing some terminological issues, the paper challenges Feinsteins' arguments indicating that meta-analysis is inherently faulted on four grounds: (a) reproducibility, (b) precision, (c) suitable extrapolation, (d) fair comparison. Each point is discussed providing examples drawn from the published literature with a view to indicate that-despite their current limitations-systematic reviews are a necessary step to synthesize information, orient clinical research and help produce practice guidelines.