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March 15, 2000

Scoring the Quality of Clinical Trials

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(11):1421-1423. doi:10.1001/jama.283.11.1421

To the Editor: As a coauthor of the original meta-analysis on low-molecular-weight heparin (LMWH),1 I have often referred to it when speaking or writing about the role of subjectivity in research.2 I am therefore not entirely surprised by the finding of Dr Jüni and colleagues3 that varying judgments on the quality of studies can lead to diametrically opposite conclusions. Nevertheless, the solution to look at individual elements of quality—albeit only those that are judged important—will always remain an ad hoc decision of a meta-analyst. Moreover, the interpretation is 1-sided: we will only believe that quality has an influence when the higher-quality studies find a lower effect. The undisputed advantage of individual scoring is that one can discuss (and disagree) more clearly whether some element of quality is important in a particular set of trials.

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