Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials
Controlled Clinical TrialsPublished 1 April 1998
Andrew J. Vickers, Niraj Goyal, Robert Harland, Rebecca Rees
Citations677
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ObjectiveStudy objective
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TL;DR
Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR.
Abstract
Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
Keywords
Social SciencesDecision Sciences
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An adjusted rank correlation test is proposed as a technique for identifying publication bias in a meta-analysis, and its operating characteristics are evaluated via simulations, and the test statistic is a direct statistical analogue of the popular "funnel-graph".
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The presence of publication bias in a cohort of clinical research studies is confirmed and it is suggested that conclusions based only on a review of published data should be interpreted cautiously, especially for observational studies.
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Important design and statistical issues of this process of combining study results that can be used to draw conclusions about therapeutic effectiveness or to plan new studies are reviewed.
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At the bedside or in the office, physicians should have instantaneous, up-to-date assistance from an affordable, universally available database of systematic reviews of the best evidence from clinical trials.
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Overall, the reporting of clinical trials appears to be biased toward an exaggeration of treatment differences, and more emphasis should be given to the magnitude of treatment Differences and to estimation methods such as confidence intervals.
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The efficacy of acupuncture in the treatment of chronic pain remains doubtful because of the quality of even the better studies, which proved to be mediocre.
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A model is developed which permits estimation of the potential magnitude by which the reported efficacy of a treatment might be inflated, termed the publication bias, which depends on the sample size of the study and the number of similar studies conducted concurrently.
