Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Section of Critical Care (Dr Zarychanski; firstname.lastname@example.org) and George & Fay Yee Center for Healthcare Innovation (Dr Abou-Setta), University of Manitoba, Winnipeg, Canada; and Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada (Dr Turgeon).
In Reply: Understanding and uncovering bias concealed within scientific studies are critical to the scientific process, and especially pertinent in the context of meta-analysis whereby unrecognized bias may be amplified. Dr Ioannidis' comments underscore the need to question the results of individual trials, or a series of individual trials, that seem to be statistically or clinically too good to be true, or that prompt one to question the validity of the presented effect estimates.1 In the context of acute volume resuscitation, considerable between-trial heterogeneity would have been expected in the small trials conducted by Boldt et al due to random sampling error.
Zarychanski R, Turgeon AF, Abou-Setta AM. Meta-analyses of Hydroxyethyl Starch for Volume Resuscitation—Reply. JAMA. 2013;309(21):2209. doi:10.1001/jama.2013.5820