Carl Heneghan, DPhil; Tom Jefferson, MD; Peter Doshi, PhD
Potential Conflicts of Interest: Dr. Heneghan: Grant (money to institution): National Institute for Health Research; Other: evidence-based training workshops book royalties, expenses from the World Health Organization, and payment from The Guardian and Channel 4 television. Dr. Jefferson: Grants: National Institute for Health Research; Consultancy: market research organizations (unrelated to infectious diseases); Expert testimony: expert opinion on a lawsuit in Seattle, Washington; Royalties: books published on peer review, critical appraisal, health economics, and HTA; Payment for development of educational presentations: presentations on peer review, critical appraisal, health economics, and HTA. Dr. Doshi: Grants/grants pending: National Institute for Health Research for a Cochrane review of neuraminidase inhibitors.
Heneghan C., Jefferson T., Doshi P.; Antivirals for Treatment of Influenza. Ann Intern Med. 2012;157:385-386. doi: 10.7326/0003-4819-157-5-201209040-00017
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Published: Ann Intern Med. 2012;157(5):385-386.
TO THE EDITOR:
We disagree with Hsu and colleagues' (1) presentation of results from their meta-analysis of observational studies. Properly reporting the results of meta-analyses of large data sets of poor-quality evidence is tricky. Large sample sizes alone will generate effect estimates with narrow CIs, but if the underlying data are of poor quality, there is no guarantee that these effect estimates are trustworthy. Hsu and colleagues graded their evidence as low- or very-low-quality, yet still presented statistically significant numerical results and concluded that oseltamivir “may reduce” mortality and hospitalization. This optimism is misplaced, for the “confounding and selection, reporting, and publication bias” they note has the potential not only to weaken but to reverse their effect estimates. In fact, our recent systematic review (2) of placebo-controlled, randomized, controlled trials (RCTs) found no effect on hospitalization (odds ratio, 0.95 [CI, 0.57 to 1.61]).
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