Within the framework of evidence-based medicine, meta-analyses represent a methodological tool to consolidate the state of knowledge on particular medical questions. However, meta-analyses per se already raise some fundamental problems. If quality criteria are not taken into account in the setting up of meta-analyses, this can result in methodological bias, so that in the final analysis, the intervention efficacy can be clearly underestimated or overestimated. Unfortunately, despite the existence of guidelines for their preparation, many published meta-analyses show considerable shortcomings as far as the methodology is concerned, and their value for the drawing up of diagnostic or therapeutic guidelines therefore has to be considered as questionable. Only a limited number of collaborative groups, for example the Cochrane Collaboration, set up meta-analyses with a high level of methodology. While their systematic reviews are to be recommended, the large number of published meta-analyses have to be viewed with scepticism, since often their results and conclusions cannot be comprehended objectively. In those areas of medicine where data and evidence are scanty, even meta-analyses cannot work wonders, because the value of a meta-analysis depends entirely on the value of the individual studies. Therefore, randomised, controlled studies will in future continue to play the decisive role in finding answers to the existing medical questions – and meta-analyses can help to formulate the right questions.

Keywords:
Randomised, controlled study, Publication bias, Selection bias, Quality standards of reporting
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© 2001 S. Karger AG, Basel
2002
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