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To the Editor.— The recent study by Dr Ioannidis¹ raises issues of importance to everyone involved in systematic reviews or meta-analyses. Although the study is restricted to one area of health care, there is no reason to believe that it will be any different in other areas in which trials with significant results have been shown to be more likely to stop early and to get published than trials with nonsignificant results. For example, Stern and Simes² recently demonstrated a similar finding for medical research studies in Sydney, Australia.

These findings should make everyone conducting or interpreting systematic reviews and meta-analyses cautious about the criteria used to select trials for inclusion in a review. Not only must those doing reviews seek data from all studies that meet their criteria for the types of participants, interventions, outcomes, and study designs they are interested in,³ they should also consider specifying a temporal . . . [Full Text of this Article]

Alejandro R. Jadad, MD, DPhil
McMaster University
Hamilton, Ontario

Drummond Rennie, MD
Deputy Editor (West), JAMA
Chicago, Ill

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