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Opinions/Hypotheses |

Is Meta-Analysis Really Meta-Physics?*

Mitchell Machtay, MD; Larry R. Kaiser, MD, FCCP; Eli Glatstein, MD
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*From the Departments of Radiation Oncology (Drs. Machtay and Glatstein) and Thoracic Surgery (Dr. Kaiser), Hospital of the University of Pennsylvania, Philadelphia, PA.

Correspondence to: Mitchell Machtay, MD, Department of Radiation Oncology, 2 Donner Bldg, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104



Chest. 1999;116(2):539-542. doi:10.1378/chest.116.2.539
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Abbreviations: AJCC = American Joint Committee on Cancer; NSCLC = non-small cell lung cancer; PORT =postoperative radiotherapy; XRT = radiotherapy

“Not everything that can be counted counts and not everything that counts can be counted.” Albert Einstein

There is a growing obsession within the medical community and the public for swift and succinct evidence-based decisions. However, the presumption of many of those who advocate this view is that only meta-analyses of prospectively randomized trials—however flawed—provide useful information. The meta-analysis of postoperative radiotherapy (PORT) in non-small cell lung cancer (NSCLC) published recently in Lancet1 well exemplifies this way of thinking.“ It should be compulsory reading for CEOs of hospitals. There is a very clear message here,” said the director general of Britain’s Cancer Research Campaign to Associated Press reporters. He congratulated the PORT researchers for “determining” that PORT for NSCLC not only failed to improve survival but actually worsened survival. The publicity generated by the PORT meta-analysis caused unwarranted fear among many lung cancer patients, who already have enough to worry about.

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