Commentary Received 11 March 2015,

Accepted 11 March 2015

Published online 10 June 2015 in Wiley Online Library

(wileyonlinelibrary.com) DOI: 10.1002/jrsm.1144

Commentary for history special issue of Research Synthesis Methods Iain Chalmers*

1. Introduction I am delighted to have been invited by Will Shadish to contribute to this history special issue of research synthesis methods. The fact that some of the pioneers of research synthesis – Fred Mosteller (Petrosino, 2004) and Tom Chalmers (Dickersin and Chalmers, 2014), for example – are no longer with us is a reminder of our responsibilities. It is already clear that the evolution of scientifically defensible reviews of research will come to be regarded as a development of fundamental importance in the history of science – a ‘Meta-Analytic Big Bang’ – as Will Shadish puts it. We owe it to future historians to ensure proper archiving of relevant material from our era and to record ‘witness statements’ such as those provided here by Frank Schmidt, Gene Glass, and Robert Rosenthal. What characteristics do reviews need to have to make them ‘scientifically defensible’? Like any other research project (Cooper, 1982), they need to take steps to reduce the likelihood that we will be misled by (i) biases of various kinds and (ii) the play of chance. If appropriate and possible, statistical synthesis of estimates from similar but separate studies can be used to deal with the second of these threats. Most of us can agree that Gene Glass’ term ‘meta-analysis’ covers the statistical synthesis of estimates from similar but separate studies (Glass, 1976); but consensus is unlikely over what term to use to cover the bias-reducing features of scientifically defensible reviews. I will use the term ‘systematic review’ because this term begs the question ‘What system was used to reduce biases?’ and demands an answer in terms of bias-reducing methods (Chalmers and Altman, 1995). ‘Meta-analysis’ is not a relevant answer to that question: statistical synthesis may actually amplify the effects of inadequately controlled biases and may or may not be used in systematic reviews. These terminological matters were touched on in a brief history of research synthesis that Larry Hedges, Harris Cooper, and I published in 2002 (Chalmers et al., 2002). There have been many relevant developments since then, and an updated history of systematic reviews is currently being prepared for publication in the James Lind Library (www.jameslindlibrary.org). As with other papers in the James Lind Library, there will be links from this history to scans of key documents and other relevant material.

2. Research synthesis in the social and health sciences The James Lind Library includes material about research synthesis from both the social and health sciences. Although relevant reports were published before the 1970s (e.g., Park et al., 1928; Pratt et al., 1940; Daniels and Hill, 1952; Leitch, 1959; Wechsler et al., 1965; Smith et al., 1969), it was not until the 1970s that the modern history of research synthesis began to gather momentum, beginning with 1971 papers by Light and Smith and Feldman. Research synthesis offered a potential solution to an increasingly acknowledged problem – the need to help those who wanted to make sense of ever larger mountains of research results and use them to inform policy, practice, and further research. By the 1980s, very readable introductions to research synthesis were becoming available such as Richard Light’s and David Pillemer’s Summing Up (1984) and Milos Jenicek’s Méta-analyse en médecine (1987). Some of us in health research first became aware of and acknowledged the research synthesis work of the (mainly) American social scientists and statisticians during the 1970s (Chalmers et al., 2002; Jenicek, 2006; Guyatt and Oxman, 2009). However, developments within health research were also occurring largely independently of those in the social sciences. In 1974, a Swedish radiotherapist combined estimates from five similar randomized trials

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*Correspondence to: Iain Chalmers, James Lind Initiative, Oxford, OX2 7LG, UK † [email protected]

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and showed that radiotherapy after surgery increased mortality in women with breast cancer (Stjernswärd, 1974). When I asked him what had led him to use statistical synthesis, he thought for a moment then said it was simply ‘bondförnuft’ – ‘peasant sense’ (Stjernswärd, 2009). Others working in heart disease, cancer, and perinatal care had arrived at similar conclusions (Chalmers et al., 1977; Peto et al., 1977; Chalmers, 1979). My impression is that any ‘crossovers’ that occurred between research synthesis work in the social and health sciences were mainly in the field of mental health and involved both psychologists and psychiatrists (for example, Smith and Glass, 1977; Davis, 1976).

3. Why so little ‘crossover’ between the health and social sciences? Why was there apparently little ‘crossover’ between health researchers and social researchers? One of the reasons probably relates to differences in the type of research material available to the two communities for synthesis. The people promoting research synthesis in health research were often also proponents of randomized trials, for which dichotomous outcomes are usual. By contrast, social scientists have had to cope with studies using a variety of research designs, with outcomes assessed using a variety of metrics. The ‘technical’ solution to this problem was to calculate ‘effect sizes’, but these yielded overall estimates of effects that were more difficult to interpret and apply in practice than relative risk reductions in dichotomous outcomes such as mortality, for example. Another possible reason may have been the rather different consequences of not synthesizing research evidence in the two spheres. Failures to synthesize the results of research assessing the effects of social and educational interventions has probably only very rarely led to avoidable deaths. By contrast, as illustrated most dramatically in an analysis led by Fred Mosteller and Tom Chalmers (Antman et al., 1992), failure to cumulate evidence about the effects of clinical treatments has probably resulted in the avoidable deaths of millions of patients.

4. Publication bias – an enduring problem for both social and health research Social scientists first provided quantified evidence of biased reporting of research (Sterling, 1959; Smart, 1964; Mahoney, 1977), and they proposed statistical approaches to dealing with the problem in research syntheses (for example, Rosenthal, 1979). A more fundamental approach was proposed by John Simes after he showed that reporting bias influenced the choice of treatments for women with ovarian cancer (Simes, 1986): he called for an international register of clinical trials. Thirty years later, international registers of clinical trials and requirements to register new studies at inception have become prominent features in the landscape of clinical research. I am unaware of any comparable developments for prospective registration of trials of social and educational interventions. Registers of clinical trials have allowed quantification of the extent of under reporting of these studies (Dickersin and Chalmers, 2010). It is substantial: reports are unavailable for about 50% of clinical trials registered at inception. The support received by the all trials campaign (www.alltrials.org) makes clear that this is now widely regarded as a scandalous betrayal of those who have participated in trials. In the UK, proposals for clinical trials will not receive ethics approval unless they have been registered (Chalmers, 2013).

5. New research should begin and end with systematic reviews Finally, I want to suggest that the researchers who have developed the science and practice of research synthesis have not been sufficiently outspoken about the ethical and scientific relevance of their work. Embarking on additional primary research without reviewing systematically what is already known is unethical, unscientific, and wasteful (Chalmers and Nylenna, 2014; Chalmers et al., 2014). Some research funders are taking a very firm view on this. The National Institute for Health Research in England, for example, advises people applying for support of new primary research as follows: Where a systematic review already exists that summarises the available evidence this should be referenced, as well as including reference to any relevant literature published subsequent to that systematic review. Where no such systematic review exists it is expected that the applicants will undertake an appropriate review of the currently available and relevant evidence (using as appropriate a predetermined and described methodology that systematically identifies, critically appraises and then synthesises the available evidence) and then present a summary of the findings of this in their proposal. All applicants must also include reference to relevant on-going studies, e.g. from trial registries (NIHR, 2013).

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And among research regulators, the guidance for researchers issued by the Health Research Authority in the UK now states “Any project should build on a review of current knowledge. Replication to check the validity of previous research is justified, but unnecessary duplication is unethical.” (Health Research Authority 2014).

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Similarly, reports of additional research that fail to interpret new evidence in the context of updated reviews of other relevant research are, in an important sense, uninterpretable. Among the principal general medical journals, The Lancet has given a lead in this respect in editorials, the most recent of which (Kleinert et al., 2014) advises authors as follows: “Research in context” “Evidence before this study This section should include a description of all the evidence that the authors considered before undertaking this study. Authors should state: the sources (databases, journal or book reference lists, etc) searched; the criteria used to include or exclude studies (including the exact start and end dates of the search), which should not be limited to English language publications; the search terms used; the quality (risk of bias) of that evidence; and the pooled estimate derived from meta-analysis of the evidence, if appropriate.” “Added value of this study Authors should describe here how their findings add value to the existing evidence (including an updated meta-analysis, if appropriate).” “Implications of all the available evidence Authors should state the implications for practice or policy and future research of their study combined with existing evidence.” Increasing recognition that, for scientific and ethical reasons, reports of new research should begin and end with systematic reviews of other relevant research (Clarke et al., 2007) is beginning to influence the behavior of research funders, research regulators, journals, and researchers themselves (Moher et al., in preparation).

Acknowledgement I am grateful to Andy Oxman for comments on an earlier draft of this paper.

References

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Res. Syn. Meth. 2015, 6 268–271

Commentary for history special issue of Research Synthesis Methods.

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