A recent article on it (https://www.onlinejima.com/read_journals.php?article=1578) has very candidly described their darker side:
Systematic reviews (SR) and Meta-analyses (MA) are increasingly published nowadays. It is well known that they provide the highest quality of evidence and provide large amounts of information on a topic. However, they are associated with many pitfalls. Though SR and MA are at the top of the hierarchy of evidence, they are related to several pitfalls. In fact, MAs have been criticised over the years, and some authors have referred to them as ‘mega silliness’ and ‘statistical alchemy.
When one gets to read an MA, one should not get carried away by the numbers, figures and plots. The SR and MA are like the lights on the floating ship of research. One has to take the results of the SR and MA with a pinch of salt, delve into the depths of the SR and ponder over the reliability of the findings before applying the conclusion in clinical practice. There is no doubt that there is a need for SR and MA, but there is an even greater need for high-quality SR and MA with rigorous research methodology.
The findings of systematic reviews and meta-analyses are not always universally helpful for clinicians, as their applicability depends on study quality, patient population relevance, and clinical context. Methodological flaws or publication bias can limit reliability. Clinicians should critically appraise and contextualize findings before applying them to patient care.
Good question! the answer is that after SRMAs there comesa question on policy and practice. The evidence geerated by systematic reviews is then evaluated for quality using GRADE framework and necessary recommendations are given for practice. However, in any context there are 3 considerations for implementation in practice. the first is the evidence generated by SRMAs or so called evidence based practice. Second is the clinicians experience and judgement which may side or contrast the current evidence considering various clinical factors in question. finally, it is the patient's preference for treatment after knowing all available options their merits and de-merits, advantages and disadvantages and so on. thus, modern day practice is based on consideration of all these 3 factors and their influence on the treatment decisions. Thanks and good luck!
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