Is Meta-Analysis Really Meta-Physics?

There is a growing obsession within the medical community and the public for swift and succinct evidence-based decisions. However, the presumption of many of those who advocate this view is that only meta-analyses of prospectively randomized trials—however flawed—provide useful information. The meta-analysis of postoperative radiotherapy (PORT) in non-small cell lung cancer (NSCLC) published recently in Lancet1 Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group. Lancet. 1998; 352: 257-263 Abstract Full Text Full Text PDF PubMed Scopus (834) Google Scholar well exemplifies this way of thinking.“ It should be compulsory reading for CEOs of hospitals. There is a very clear message here,” said the director general of Britain's Cancer Research Campaign to Associated Press reporters. He congratulated the PORT researchers for “determining” that PORT for NSCLC not only failed to improve survival but actually worsened survival. The publicity generated by the PORT meta-analysis caused unwarranted fear among many lung cancer patients, who already have enough to worry about.