Nature Medicine · 5 authors, 6 centres
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This letter critiques the methodological approach of the 'Burden of Proof' meta-analyses, arguing their uncertainty intervals are excessively wide, leading to an oversimplified star-rating system that may cast undue doubt on established public health relationships like smoking and ischemic heart disease.
This narrative review critiques the methodology of the 'Burden of Proof' (BoP) meta-analyses published in Nature Medicine. The authors argue that the BoP's method for calculating uncertainty intervals (UIs) inflates them excessively compared to conventional meta-analysis methods, which can lead to misleadingly low star ratings for well-established risk factors. As an example, they re-analyze data on unprocessed red meat and type 2 diabetes, showing a statistically significant positive association with much narrower confidence intervals than the BoP reported. They contend the star-rating system is overly simplistic, fails to consider the totality of evidence (e.g., mechanistic studies, randomized trials), and could undermine public health recommendations. The authors suggest that pooling individual-level data and using standard dose-response modeling are superior approaches for synthesizing evidence on complex exposures.
