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Truth Survival in Clinical Research: An Evidence-Based Requiem?

Thierry Poynard, MD, PhD; Mona Munteanu, MD; Vlad Ratziu, MD; Yves Benhamou, MD, PhD; Vincent Di Martino, MD; Julien Taieb, MD; and Pierre Opolon, MD
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From Groupe Hospitalier Pitié-Salpêtrière, Paris, France.

Acknowledgment: The authors thank Solko Schalm, MD, for his support and helpful comments.

Grant Support: By the European Association for Study of the Liver and Association pour la Recherche sur Maladies Hépatiques Virales.

Requests for Single Reprints: Thierry Poynard, MD, PhD, Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; e-mail, tpoynard@teaser.fr.

Current author addresses: Drs. Poynard, Munteanu, Ratziu, Benhamou, Di Martino, Taieb, and Opolon: Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.

Ann Intern Med. 2002;136(12):888-895. doi:10.7326/0003-4819-136-12-200206180-00010
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Purpose: Factors associated with the survival of truth of clinical conclusions in the medical literature are unknown. The authors hypothesized that conclusions derived from studies using better methodology should have a longer half-life.

Data Sources: MEDLINE and hand searches of journals with studies on cirrhosis and hepatitis.

Study Selection: Original articles and meta-analyses published from 1945 to 1999 about cirrhosis or hepatitis in adults.

Data Synthesis: In 2000, 285 of 474 conclusions (60%) were still considered to be true, 91 (19%) were considered to be obsolete, and 98 (21%) were considered to be false. The half-life of truth was 45 years. The 20-year survival of conclusions derived from meta-analysis was lower (57% ± 10%) than that from nonrandomized studies (87% ± 2%) (P < 0.001) or randomized trials (85% ± 3%) (P < 0.001). The survival of conclusions was not different when studies of high methodologic quality were compared with those of low quality. In randomized trials, the 50-year survival rate was higher for 52 negative conclusions (68% ± 13%) than for 118 positive conclusions (14% ± 4%) (P < 0.001).

Conclusions: Contrary to the authors' hypothesis, conclusions based on recognized, good methodology had no clear survival advantage. To better convince clinicians of the long-term utility of evidence-based medicine, better prognostic factors should be developed.


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Figure 1.
Truth survival in original articles and meta-analyses on hepatitis and cirrhosis.

The top panel shows the percentage of studies without false or obsolete conclusions. At 50 years, the mean survival (± SE) was 26% ± 4%. The bottom panel shows the percentage of studies without false conclusions. At 50 years, the mean survival (± SE) was 53% ± 5%.

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Figure 2.
Truth survival in meta-analyses.

Twenty-year mean survival(±SE) was lower in meta-analyses (57% ± 10%) than in other studies(87% ± 2%).

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