What does the Systematic Review of Systematic Reviews tell us?

I have attached a recent editorial by Ann Moore and Gwen Jull commenting on Ernst’s Systematic Review of Systematic Reviews of Manipulation paper. Some of the issues associated with the paper are illustrated and the authors make a call to “get back to proper science”.

Additionally, I have attached an editorial from 2004 that Dr Jull put together on classification systems in clinical practice. Thanks to Dan Pinto for passing this one along.

Josh

Download Moore_Jull_Sys_review_of_sys_reviews_2006.pdf

Download Jull_editorial_classification_clin_practice.pdf

Comments

[Britt]

Josh,
Interesting commentaries on Ernst's SR of SRs and the classification systems. I am reminded of commentaries by Richard DiFabio PhD, PT, past editor of JOSPT. His criticisms of EBM and NIH/Cochrane collaboration (or he would have us believe conspiracy) were over-the-top, however, he was on mark about the realpolitik of medicine. Ernst paper has been fairly well discussed in the prior blog (April 4). Ernst has an agenda against chiropractic, and so also manipulation. Ernst has unreal criteria for good RCTs in manipulation (he would have double blinded studies with a sham manipulation (placebo), both of which are pragmatically impossible).Assendelft et al JAMA 1995 found that studies with manipulators as reviewers are more likely to have positive findings, and they state it may be equally true that reviews with non-manipulators as reviewers are as likely to be negative. I believe Ernst's paper represents the latter...as did the SR in Annals of Internal Medicine 1994 headed up by Assendelft.
I believe at the end of the day, inevitably, reviews (systematic or not) will reflect the opinions of the Reviewers. Any thoughts?
Britt

[Britt]

I meant the 'the SR in Annals of Internal Medicine in 2003'
...sorry about the mis-blog [Assendelft et al. Spinal manipulative therapy for low back pain, a meta-analysis of effectiveness relative to other therapies. Ann Int Med. 2003;138:871-881.]
Britt

[Rob Wainner]

G. Jull makes several excellent points, and papers like the one published by Ernst and colleagues give EBP a bad name and do nothing but muddy the water.

Gwendolyn did more than just critique a poor editorial masquerading as science, she laid out a plan for moving forward. One suggested item was some consistency regarding terminology used. The standardization of terminology and elimination of jargon was blogged and commented on fairly extensively earlier (http://blog.evidenceinmotion.com/evidence/2006/03/index.html), but dont believe I have seen any definitive action come about. Takers, anyone?