There are so many reasons to address the area of value in evidence synthesis….
Broadly, I get depressed by the lack of challenge to the hegemonic position of long-winded systematic reviews in the world of EBM.
If it was proven that systematic reviews, using ‘standard’ methods produced ‘accurate’ answers then I’d be more sympathetic. But it’s demonstrably true that systematic reviews, based on published journal articles, cannot be relied upon to give an accurate assessment of the ‘worth’ of an intervention (for instance, see Some additional thoughts on systematic reviews).
So why spend so long doing them?
It’s another post (for the future) about the reasons for undertaking systematic reviews – I still struggle with the reasons. But the reason for doing the systematic review should lead the method, it just feels too simplistic at present, too knee-jerk – ‘we must do a systematic review’, with little thought behind why we’re doing it in the first place.
Within EBM there is a growing realisation that things – broadly – need to change. I involved in the Evidence based medicine: a movement in crisis? paper. I see the paper being representative of a pause between two ages: arguably between the first age of EBM and a second age. The thinking and assumptions have changed and are maturing. This seems an ideal time to explore a problem in EBM, the production of useful evidence via evidence synthesis.
Resource is tight, so any solution needs to increase value. This can be achieved in any number of ways e.g reducing costs, increasing usefulness. Quoting from the ‘movement in crisis’ paper:
Lengthy and expensive reviews that are “methodologically robust” but unusable in practice often fail to inform, inspire, or influence.
Bottom line: this blog is for people who think things need to change in relation to evidence synthesis. If you support the status quo and are afraid of challenge then best not come back!