Medical decisions are complex. Hundreds, if not thousands, of studies have often been published that may influence how medical conditions are managed.
Some studies are investigating which drugs are best in certain situations, or whether it is better to treat pain, for example, by avoiding exercise or by going to a physical therapist for a massage.
In this morass of difficult choices, Cochrane Reviews stand out as internationally trusted and independent. They are considered the “gold standard” in evidence-based medicine.
A research team reviews all published academic research on a subject to come up with a holistic answer about what the best evidence says about different treatments.
However, Cochrane recently faced criticism after a controversial review investigating whether wearing masks in communities during the COVID-19 pandemic could be effective in reducing the spread of respiratory viruses. bathing.
Studies like this can raise questions about how useful Cochrane reviews are, especially for the general public.
Issues in Evidence-Based Medicine
Like any research process, Cochrane reviews are not perfect. And we can’t answer all medical questions.
The entire process of collecting data, based primarily on randomized clinical trials, and reviewing that data to come to some conclusions about the evidence, was developed mostly in the context of clinical intervention. A randomized trial is a type of medical study in which people are given a treatment in a controlled, random way to get a good estimate of whether the treatment works for the condition being studied.
People regularly question whether this “gold standard” framework does well for things other than surgery, drugs, and the like.
For example, consider the mask review above. Much of the criticism focused on the general idea of whether randomized clinical trials were an appropriate way to measure the effects of masks on respiratory disease, rather than the details of the papers included. .
What are the “golden rules” when randomized trials are impossible, unethical, or inappropriate? You can’t just randomize people into groups who don’t receive treatment.
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This raises the fundamental question of what Cochrane Reviews actually exist for. The main purpose of aggregating surveys in this way is to filter out noise and provide the most accurate data on any given question.
Sometimes the most honest answer is that there isn’t enough evidence to draw a conclusion.
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In other cases there is evidence but not from randomized clinical trials. Then there is the discussion of how much weight to give to this evidence, whether and how to include it, and how to draw conclusions based on this data.
While this may seem arbitrary, there are good reasons to be wary of findings based solely on observational studies. A systematic review of observational trials of hormone replacement therapy led to its widespread use for preventive health purposes in the late 90s, but randomized trials showed this therapy had little effect.
Actually this is not a new problem. In fact, this is a problem Cochrane has been grappling with for years.
For example, a recent Cochrane review of e-cigarettes that help people quit smoking included a significant number of non-randomised trials. Although they were not given the same weight as the randomized studies, they did support the central findings of the review.
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Cochrane doesn’t mind being criticized…
Many issues have been raised by Cochrane’s team over the years. This includes the question of how reviewers evaluate trials included in the review.
However, the organization is known for its transparency. If you have an issue with a particular review, you can post a public comment. I did this and shared my concerns about reviews regarding the use of the novel coronavirus drug ivermectin.
Cochrane is also good at taking criticism. He has also won the Best Criticism Award for his work.
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…even if the review takes a long time
There’s a reason so many professionals trust Cochrane. Apart from the occasional controversy, Cochrane’s reviews are generally the most detailed and rigorous summaries of the evidence on any question that can be found.
This attention to detail comes at a cost. Cochrane reviews are often the final word on a subject. Not only is the review very robust, but it also takes a very long time to come to fruition.
Cochrane aims to publish a review within two years. But more than half of them take a long time to complete. Cochrane’s reviews are also supposed to be updated regularly, but many have not been updated in his five years or more.
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in a nutshell
Cochrane reviews may be flawed, may not answer all medical questions, and, while comprehensive, may take longer to complete.
But there’s a reason these reviews are considered the gold standard in medical research. It is a long, detailed and very impressive work.
With over 9,000 Cochrane reviews to date, these are usually the best evidence for answering a wide variety of medical questions.