Is the research you value a waste of money?

Introduction and Hypothesis: Eighty-five percent of health research may be wasted, resulting in $170 billion annually in wasteful research spending worldwide. Given the increased use of randomized trials and their influence on medicine, one method to combat research waste is to conduct RCTs only when a systematic review (SR) suggests more data are needed or when no previous systematic reviews are identified. Here, we hypothesize SRs would be rarely cited as justification for conducting RCTs.

Methods: We analysed RCTs published between 2016 and 2018 in New England Journal of Medicine, Lancet, and Journal of the American Medical Association. We performed duplicate and independent data extraction to ensure the accuracy and validity of our data. For each trial, we extracted whether SRs were cited as justification for conducting the clinical trial.

Results: Our search retrieved 665 records, of which 628 were included. Overall, 706 SR’s were cited in these 628 RCTs; of which, 318 were referenced in the introduction, 82 in the methods, and 306 in the discussion. 49 SRs were cited verbatim as justification for conducting the trial. RCTs published in Lancet were more likely to cite a SR as justification for conducting the trial.

Conclusion: Very few clinical trials cite systematic reviews as the basis for undertaking the trial. We believe trialists should be required to present relevant systematic reviews to an ethics or peer review committee demonstrating an unmet need prior to initiating a trial. Eliminating research waste is both a scientific and ethical responsibility.