Medicine and Multimedia: How Science Takes Stock: the Story of Meta-analysis

Morton Hunt Morton Hunt has mastered the seemingly impossible task of conveying to a broad range of readers, in a language that can be understood by all, the genesis and development of meta-analysis. Although only recently “discovered” in medicine, meta-analysis has a longer tradition in the social sciences, particularly psychology, and this is where Hunt begins his story. Many of the personalities who helped develop meta-analysis are interviewed, including Gene Glass, Joseph Lau, Graham Colditz, and both Iain and Tom Chalmers. Several important developments are reviewed, including the recent development of the Cochrane Collaboration. What is missing, probably because of publishing deadlines, is the recent development by the US Agency for Health Care Research and Policy to fund several centres for evidence based practice. Its association with the Cochrane Collaboration and other groups will be important to foster. What Hunt uncovers, and which I believe is little known within medicine, is the contribution that meta-analysis has made in helping develop social policy, particularly in the United States. Much of this work has been conducted by the Program Evaluation and Methodology Division of the General Accounting Office—examples of its work include comparing the surgical treatments of lumpectomy and mastectomy for breast cancer, and determining the appropriate driving age for particular states. Unfortunately, Hunt informs us, the division has been disbanded, another casualty of “downsizing.” Throughout the book several statistical procedures for combining seemingly disparate data from individual studies are explained. The discussions of these “effect sizes” are nicely threaded together, with additional examples and explanations, in an appendix by Harris Cooper, a prominent scientist in the development of meta-analytical techniques. Social scientists have been more liberal than their medical counterparts in how to handle issues of subgroup analysis and sensitivity analysis. It is possible that the medical community will embrace the use of meta-regression to help tease out the various contributions that independent factors have on estimates of a treatment’s effectiveness. For the sceptics, there is even space devoted to some of the problems and pitfalls facing the continued development of this science. More attention could have been given to some issues highlighted through meta-analysis. We now have a more complete understanding of issues surrounding publication bias, less tolerance for underreporting of research, and have uncovered the occasionally less than desirable behaviour of some authors and the pharmaceutical industry. Most of these experiences can be transferred to other areas of research and are the result of rigorous efforts to improve the conduct of meta-analysis. The issue of standards for the reporting of meta-analyses is not discussed either, perhaps awaiting the second edition. Overall, I think the book is great reading, even on holiday, which is when I read it. It will be particularly important for those interested in the thorny issue of how to use the results of meta-analysis to help develop useful policies for improving the health of the nation. There is nothing morally repugnant about supplying your own health care: you are freeing up the NHS to look after somebody else. She [matron] was a dragon and she was a champion and we want her back. Ann Widdecombe, shadow health secretary, at the Conservative party conference   I did that service, I did it well and I deserve to be paid. If you call out a plumber in an emergency you would expect to receive a bill. Dr John Stevens, consultant psychiatrist, in his quest for £540 from American Airlines for responding to an in-flight medical emergency SEPTEMBER BESTSELLERS 1 Oxford Handbook of Clinical Medicine, 4th edRA Hope, JM Longmore, SK McManus, CA Wood-AllumOUP, £14.95, ISBN 0 19 262783 X 2 Oxford Handbook of Clinical Specialties, 4th edJAB Collier, JM Longmore, TJ HodgettsOUP, £14.95, ISBN 0 19 262537 3 3 Hot Topics in General Practice, 2nd edE StaceyBios Scientific, £24.95, ISBN 1 85996 251 3 4 Stedman’s Pocket Medical DictionaryWilliams and Wilkins, £5.95, ISBN 0 683 14528 2 5 Essential Statistics for Medical ExaminationsB Faragher, C MargueriePastest, £13.50, ISBN 0906896827 6 Notes for the MRCGP, 3rd ed (updated for the new modular MRCGP exam)KT PalmerBlackwell Science, £19.95, ISBN 0 86542 777 1 7 Evidence Based Medicine: How to Practice and Teach EBMDL Sackett, W Scott Richardson, W Rosenberg, RB HaynesChurchill Livingstone, £15.50, ISBN 0 443 05686 2 8 The Insiders’ Guide to Medical SchoolsS Calvert, I UrmstonBMJ Books, £9.99, ISBN 0 7279 1269 0 9 Oxford Handbook of Acute MedicineP Ramrakha, K MooreOUP, £16.95, ISBN 0 19 262682 5 10 How to Read a Paper: The Basics of Evidence Based MedicineT GreenhalghBMJ Books, £14.95, ISBN 0 7279 1139 2