Reviewing systematic reviews and analyzing meta-analyses

摘要

Plastic surgeons love to compare things. It is fun to compare our patients' pre- and post-operative images and oftentimes we learn something when comparing others' pre- and post-operative images in a paper or presentation. Comparing images is usually subjective. We use our aesthetic judgment to decide what is pleasing and what is not. We do not glue ourselves to LCD screens and use imaging software to count pixels and measure angles in order to objectively measure differences. That is not how we practice objective plastic surgery. Rather, we use evidence-based medicine.Danger at the top of evidence-based medicine pyramid We are familiar with the evidence-based medicine pyramid that has opinion at the bottom and systematic reviews at the top. Recently, I realized that a subliminal message is conveyed when knowledge is classified hierarchically with this pyramid. It reminded me of the Aztecs. Altars existed at the top of the Aztec pyramid, so that sacrifices could be made to assuage the gods. By analogy, it is dangerous for us to sacrifice our skepticism on the altar of evidence-based medicine by blindly accepting the conclusions of systematic reviews and meta-analyses as if they were part of some quasi-religious ritual.