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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25/n Somehow there are more issues here. This study was included in the risk of bias, but even though it assessed honey vs placebo/salbutamonl (and found no effect) it is not in any of the meta-analyses Very weirdpic.twitter.com/8AaMA85ERm
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26/n This is even weirder when you consider that the authors report excluding a study for not providing data So they exclude one study and report it, but another just...disappears? So strangepic.twitter.com/oyrp57yP1Y
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27/n Another included study using a per-protocol analysis. This was at least rated correctly as at a high risk of biaspic.twitter.com/t2mRMIq539
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28/n Another one. This study was rated at low risk of bias for most domains. Here's how they described their randomization and allocation concealment. What do you think?pic.twitter.com/1NM606xcRg
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29/n I'll give you a head-start - if they literally don't report ~how~ patients were randomized, by definition this should be unclear or high risk of bias for the domain of random sequence generation
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Replying to @GidMK
Excellent summary. The devil really is in the detail. Frustrating to see so many low quality studies with "optimistic" interpretations as it just polarises debates that seem easy and worthwhile to answer. Did any of the studies seem to be correctly graded as at low risk of bias?
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The only I could find before I gave up was Cohen 2012
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