JAMA
August 20, 2014, Vol 312, No. 7
http://jama.jamanetwork.com/issue.aspx

Editorial | August 13, 2014
Meta-analysis as Evidence Building a Better Pyramid
Jesse A. Berlin, ScD1; Robert M. Golub, MD2
JAMA. 2014;312(6):603-605. doi:10.1001/jama.2014.8167.
Initial text
In following the practice of evidence-based medicine, when faced with a question about prevention or treatment the clinician should seek out the best evidence that addresses the question. If quality of evidence is considered a pyramid, what category should be placed at the peak? One dogma argues that it is the best-conducted randomized clinical trial (RCT) comprising patients similar to those seen by the clinician, reasoning that a well-done RCT mimics pure experimental conditions better than any other study design, hence minimizing the likelihood of confounding. A counterargument is that the best evidence is a systematic review with meta-analysis, because this approach can integrate all of the relevant evidence and provide a more reliable answer than a single study, however well conducted….