A recent RC that examined the effectiveness of medication use in treating borderline personality disorder illustrates both the power and limitations of the Cochrane methodology. The researchers carried out searches in 20 databases to reach more than 25 thousand initial articles. They narrowed this down to 45 randomized Avatropag 20 Mg (Avatrombopag Maleate) controlled trials, which were more closely examined for bias, question specificity, transparency/relevance of methodology, and a variety of other predefined criteria. This list of criteria that funnels many studies into only the most relevant is both a strength and a criticism of the Cochrane approach. On the one hand, it standardizes the way of approaching a clinical problem so that, whether the review is carried out in Seoul or Buenos Aires, the reader knows what to expect, almost like a franchise. However, the strict inclusion and exclusion criteria used may result in potentially relevant and more qualitative studies being left out.
After examining all trials that have passed through their critical pipeline for bias, heterogeneity, and other parameters, the authors of this article conclude that there is no high-quality evidence to support the use of any pharmacotherapy for borderline personality disorder per se. although some medications may help with some specific symptoms, such as aggression or dissociation. The ability to confidently state that there is currently not enough information to give a definitive answer to a question is another advantage of the Cochrane methodology.
For most of us, CRs are considered remarkably reliable, even when the results are not as directive as we might hope. This does not mean that the system itself is not flawed. Borderline personality disorder is a complicated problem, but even so, this review's 379-page report is frightening to consider at the point of care, particularly considering that there is another separate report on psychological therapies from 2020 ( 522 pages). Processing the meticulously detailed Cochrane reviews is so onerous that there is even an entire group to conduct "umbrella reviews," or "review summaries," designed to reduce the painful work of locating and assimilating high-quality evidence. In addition to the length of the articles, there are variabilities reported both in the criteria used to include studies and in the way the results are presented . Furthermore, Cochrane reviews are not as useful for summarizing observational data, and although they attempt to reduce publication bias, it is a persistent weakness in their method. The group is aware of its own limitations and is actively trying to improve .
The trick is to find an umbrella reviewer of RCs who is equally transparent and trustworthy. DynaMed editors work tirelessly to be one of those resources. We hope that by our 30th anniversary we will have as good a reputation as Cochrane. Happy birthday to everyone in the Cochrane Collaboration!