9/n Moreover, the risk of bias assessment in the systematic review is, as far as I can tell, incorrect. The authors of these studies do not report, for example, how the randomization procedure was generatedpic.twitter.com/B4C8gf8D3d
Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email gidmk.healthnerd@gmail.com he/him
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9/n Moreover, the risk of bias assessment in the systematic review is, as far as I can tell, incorrect. The authors of these studies do not report, for example, how the randomization procedure was generatedpic.twitter.com/B4C8gf8D3d
10/n They also don't describe blinding of clinical staff, and actually from reading I'm fairly sure the doctors could tell which medication the patients were taking
11/n Another issue for the SR/MA is that the data extraction from one of these studies is just wrong Here, honey has a mean reduction of 2.4 in cough frequency compared to 1.2 for 'usual care'pic.twitter.com/ucdT2kwMzO
12/n Now, firstly, that's the reduction not for "honey" but for "honey + coffee", and it's being compared to a control of "coffee alone" which is definitely not what this analysis is looking atpic.twitter.com/tLFg7h58Dn
13/n But further to this, the number given in the meta-analysis of -2.4 is wrong, as it should be 3.0-0.4 = -2.6 So it's wrong in two ways, both of them very bad for this analysis
14/n I should also mention, both of these studies were rated as at low/moderate risk of bias in the systematic review. Have a look yourself and see if you think that this is reasonable: https://www.sid.ir/en/journal/ViewPaper.aspx?ID=196449 … https://www.nature.com/articles/pcrj201372#Sec9 …pic.twitter.com/UnJ3TNif3y
15/n I haven't gone through every study yet, but every one that I have is similarly worrying. I can't actually find a study that I'm not worried about in this analysis
16/n If I go through the studies, I really can't find any that I would rate as a "low" risk of bias. Most of them are "high", some of them are really worryingly bad
17/n Given this, I'm not sure the conclusions of the review make much sense at all. How can you interpret studies of this quality as moderate/strong evidence???pic.twitter.com/mvlxiUAvJX
prepared to ignore poor quality meta if it leads to fewer antibiotic prescriptions
What if it leads to lots of people taking honey instead of getting treatment for their persistent coughs?
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