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In Reply: We agree that meta-analyses must always be interpreted with caution, as they are challenged by the "mixed salad principle," that is, by the heterogeneity of evidence reported.¹ However, a number of methods exist that allow researchers to integrate heterogeneous evidence to examine the consistency and applicability of findings across studies of various types.² Ideally, systematic reviews would include all relevant studies, regardless of language of publication. Limited time and resources may preclude such an approach.

The review cited by Drs Sawka and Thabane analyzed the conclusions of published meta-analyses and found that excluding trials published in languages other than English actually made little practical difference in terms of outcome; in fact, such language exclusions led to more conservative estimates of treatment effects.³

Sawka and Thabane state that it was unclear why we selected 8 of the 11 studies for the pooled analysis. We specifically stated that "we applied . . . [Full Text of this Article]

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