Intended for healthcare professionals

Rapid response to:

Education And Debate

Users' guide to detecting misleading claims in clinical research reports

BMJ 2004; 329 doi: (Published 04 November 2004) Cite this as: BMJ 2004;329:1093

Rapid Response:

No economic interest?

Roberts characterizes as a "slur" the idea that the results of the
Cochrane albumin meta-analysis were aligned with the economic interests of
the NHS, which provided funding for the meta-analysis in the form of
infrastructure support. This denial is contrary to a 1999 presentation on
the topic of securing funding for Cochrane reviews, in which Iain
Chalmers, the head of the UK Cochrane Collaboration at that time, stated:

"Estimates suggest that annual savings to the NHS resulting from
reduced use of human albumin solution alone are three times greater than
the total investment in Cochrane work in the UK" [1].

To this day the Cochrane Collaboration continues to make known the
savings on albumin costs effectuated by their meta-analysis

The Cochrane albumin meta-analysis has been controverted both by a
more comprehensive meta-analysis of Wilkes and Navickis [2] and the large-
scale SAFE randomized trial [3]. Roberts contends that the discrepancies
between the two meta-analyses can be ascribed to different inclusion
criteria but makes no mention of the SAFE trial results. In any case, we
dispute the claimed explanation for the disparities between the two meta-
analyses. In reality the contrasts in inclusion criteria were minor and
their impact nearly nihil. Specifically, the differences were the
inclusion of paracentesis and hemodilution trials by Wilkes and Navickis
but not the Cochrane investigators. If the single included paracentesis
trial [4] and single included hemodilution trial [5] are excluded from the
Wilkes and Navickis meta-analysis, the pooled relative risk for death is
1.09 (CI, 0.93-1.27) compared with 1.10 (CI, 0.95-1.28) without the
exclusions. The true reason for the discordant results was the reliance by
the Cochrane investigators on a small, biased subset of the pertinent

Mahlon M. Wilkes and Roberta J. Navickis

1, Chalmers I: Funding support for ensuring that Cochrane Reviews are
up to date and correct. Presented at the 7th Annual Cochrane Colloquium,
Rome, October 9, 1999

2. Wilkes MM, Navickis RJ: Patient survival after human albumin
administration: a meta-analysis of randomized, controlled trials. Ann
Intern Med 135:149-164, 2001

3. SAFE Study Investigators: A comparison of albumin and saline for
fluid resuscitation in the intensive care unit. N Engl J Med 350:2247-
2256, 2004

4. Ginès P, Titó L, Arroyo V, Planas R, Panés J, Viver J, Torres M,
Humbert P, Rimola A, Llach J, Badalamenti S, Jiménez W, Gaya J, Rodés J:
Randomized comparative study of therapeutic paracentesis with and without
intravenous albumin in cirrhosis. Gastroenterology 94:1493-1502, 1988

5. Hallowell P, Bland JH, Dalton BC, Erdmann AJd, Lappas DG, Laver
MB, Philbin D, Thomas S, Lowenstein E: The effect of hemodilution with
albumin or Ringer's lactate on water balance and blood use in open-heart
surgery. Ann Thorac Surg 25:22-29, 1978

Competing interests:
None declared

Competing interests: No competing interests

08 December 2004
Mahlon M. Wilkes
Consulting Statistician
Roberta J. Navickis
Hygeia Associates, 17988 Brewer Rd., Grass Valley, CA 95949 USA