Intended for healthcare professionals

Rapid response to:


Missing clinical trial data: setting the record straight

BMJ 2010; 341 doi: (Published 12 October 2010) Cite this as: BMJ 2010;341:c5641

Rapid Response:

Dare to use your intelligence

We agree with Loder and Godlee that selective reporting must call
into question the entire evidence synthesis enterprise. Loder and Godlee
mention the effect that selective reporting may have on systematic reviews
and meta-analyses. As practicing clinicians however we are particularly
concerned by the consequence that failure to disclose negative results may
have on practice guidelines . Like systematic reviews and meta-analyses,
guidelines can only be as good as the sum of the individual studies they
derive from. Differently from systematic reviews and meta-analyses,
however, guidelines have the power to immediately dictate clinical
practice. In this context,the fact that studies that fail to show benefit
are not accounted for is of particular concern because it unavoidably
leads to inflated perception of the efficacy of our interventions (1) and
excessive medicalization of society (2). It is of particular concern that
even in the best guidelines the proportion of recommendations unsupported
by conclusive evidence may be growing (3). Ultimately the most important
message that the reboxetine study may convey to practicing clinicians is
not to be afraid to use their own intelligence (4).


(1) Turner EH, Matthews Am et al. Selective publication of
antidepressant trials and its influence on apparent efficacy. New Engl J
Med 2008 vol. 358 : 252

(2)Getz L, Sigurdsson Ja et al. Estimating the high risk group for
cardiovascular disease in the Norwegian Hunt 2 population according to the
2003 European Guidelines : modelling study. Brit Med J 2005 vol. 331 : 551

(3) Tricoci P, Allen JM et al. Scientific evidence underlying tha
ACC/AHA clinical practice guidelines. J Am Med Ass 2009 vol. 301 : 831

(4) Heath I. Dare to use your own intelligence. Brit Med J 2008 vol.
337 : 434

Competing interests: No competing interests

17 October 2010
Piero Baglioni
Consultant Physician
Oneybuchi Okosieme Consultant Physician
Prince Charles Hospital Merthyr Tydfil CF47 9DT