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
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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
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18/n I'm also worried about the heterogeneity of the 'usual care' groups across studies. Some of the usual care: - coffee - paracetamol - syrup - diphenhydramine - placebo - prednisolone These are very much not the same!
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19/n That's a big issue because you can't really combine the effect of coffee with diphenhydramine and expect it to make sense, but that's what the authors did
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20/n Ultimately, I think the only real conclusion you can draw here is that we have very little idea whether honey reduces symptoms for URTI/cough, and that the research is quite problematic
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21/n Not something that'll make headlines, perhaps, but sadly that's often how these things go
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22/n N.B. this study has already hit ~800 on Altmetric, been covered internationally, and made huge newspic.twitter.com/bj72yqShfA
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23/n Something else I didn't mention. Every study that I've looked at so far used a per-protocol analysis, which is a huge and worrying issue All of these should be at a high risk of attrition bias, yet none were rated as such. Most of them were green (low risk)pic.twitter.com/Y6sXlnkJHe
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24/n I've gotta say, for anyone teaching students about how finicky bias can be in systematic reviews, this is a beautiful example of getting it wrong
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Replying to @GidMK
I filed those media reports under "I bet it's not what that study says".
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It kind of is, which is the most worrying part 
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