Thierry Poynard, MD, PhD; Mona Munteanu, MD; Vlad Ratziu, MD; Yves Benhamou, MD, PhD; Vincent Di Martino, MD; Julien Taieb, MD; Pierre Opolon, MD
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, email@example.com.
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.
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.
MEDLINE and hand searches of journals with studies on cirrhosis and hepatitis.
Original articles and meta-analyses published from 1945 to 1999 about cirrhosis or hepatitis in adults.
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).
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.
Poynard T, Munteanu M, Ratziu V, et al. Truth Survival in Clinical Research: An Evidence-Based Requiem?. Ann Intern Med. 2002;136:888–895. doi: 10.7326/0003-4819-136-12-200206180-00010
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Published: Ann Intern Med. 2002;136(12):888-895.
Gastroenterology/Hepatology, Liver Disease.
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