Blog: What’s Happening When Living Systematic Reviews…Stop? by Hilda Bastian

[Andy]

I’m not sure when the name “living systematic review” was coined, but it was fleshed out in an article in 2014 by Julian Elliott and co. The name was new, though the concept – staying on top of new clinical trials and keeping meta-analyses very up-to-date – has been around for over half a century. As Elliott’s article pointed out, it was the idea Iain Chalmers was immersed in back in the 1980s, making it a reality in care around childbirth for a while. And he excited a bunch of us to set out to achieve it across all of healthcare in the Cochrane Collaboration in the early 1990s.

I didn’t know it then, but the US Congress had mandated its National Cancer Institute at the NIH to do something similar even earlier. The NCI started with just a database of its own clinical trials in 1977, eventually expanding to all cancer trials. In 1980, they started summarizing the content for clinicians, and along the way created patient versions, too. In 1984, they moved to formal evidence assessment methods, and the project was named PDQ, for Physician Data Query. PDQ went online in 1995. As far as I know, it’s still the only large-scale non-commercial effort that’s pulled something like this off across decades.

The journal for Cochrane reviews was launched in 1995, too. We didn’t call them living systematic reviews, though that’s what they were meant to be. We just declared that all reviews “must be prepared systematically and they must be up-to-date to take account of new evidence.” Cochrane reviews, we said, would be “updated and amended as new evidence becomes available and errors are identified.” Ha! You can’t fault us for lack of ambition, that’s for sure!

https://absolutelymaybe.plos.org/2022/10/07/whats-happening-when-living-systematic-reviews-stop/

 

[Hutan]

Image by Hilda from Hilda's blog.
"Zombie" seems like a perfect term for the existing Cochrane Exercise Therapy for CFS review - it's long dead, but it continues to walk mindlessly, causing harm.

So, Hilda is saying that Cochrane reviews should be regarded as living reviews, subject to updating as 'errors are identified':

The journal for Cochrane reviews was launched in 1995, too. We didn’t call them living systematic reviews, though that’s what they were meant to be. We just declared that all reviews “must be prepared systematically and they must be up-to-date to take account of new evidence.” Cochrane reviews, we said, would be “updated and amended as new evidence becomes available and errors are identified.” Ha! You can’t fault us for lack of ambition, that’s for sure!

And there should be collaborations between organisations:

Pooling resources and sharing data – and not just within organizations – seem critical to me. I still think that we need meta-collaborations for each stage of the process that involves intellectual effort, from the ground up, to keep up on a major scale

Like making use of careful examinations of the evidence done by credible agencies like NICE to determine that zombie reviews should receive the archival equivalent of a 'quick blow to the head'?

I don't know what is going on with the Exercise Review process that Hilda has been leading for, I forget, a couple of years now? but there's either some fierce arguments going on behind the scenes in Cochrane, or this blog is extraordinary irony.

@Hilda Bastian

 

[rvallee]

"Living" systematic reviews sound more like a PR thing. That was supposed to happen for Long Covid and they are basically zombies already, barely 2 years old and already abandoned. Even recent updates to early guidelines on Long Covid are devoid of any learning.

Frankly the whole systematic reviews and hierarchy of evidence is mostly BS with bits of PR. Evidence-based medicine is mostly a political process and I doubt it survives for long. It became completely silly when people started calling for RCTs on masks and ventilation and a bunch of other nonsense.

EBM is basically GIGO, garbage in garbage out, on steroids. The day Cochrane closes doors will be a turning point in this mess. The organization is emblematic of this mistake and is showing it can't be reformed.

 

[Trish]

Thread on the ME exercise review here:
Independent advisory group for the full update of the Cochrane review on exercise therapy and ME/CFS (2020), led by Hilda Bastian
I'm surprised Hilda doesn't mention this review at all in this article, neither the problem of the old one being a zombie review, nor her role in leading the IAG for the new review.

 

[NelliePledge]

Maybe it’s more of a shot across the bows, those with influence in Cochrane must surely know the relevance.

eventually someone who knows what’s gone on behind closed doors will spill the beans