Like any research methodology, it is possible for those with a vested interest to twist the conclusions of a systematic review to their own advantage. Thus, one could conveniently fail to include one crucial study that went against the results you wanted to show, or if it is declared within the review, find a weak excuse to exclude it post hoc. Because many trials never see the light of day in terms of publication and are held as "data on file" by many pharmaceutical companies, it is possible for a review done by a company to include additional unpublished studies that favour their product (whereas similar studies from competitors remain buried). As with any written document assessing drug treatments, there is plenty of scope for undue emphasis on positive effects and lack of discussion of relevant adverse events. As with any other study, readers need to develop a

"good nose" for what constitutes a good systematic review and clinical trial; some pointers are given in Chapters 8 and 9. This includes a peep at the acknowledgements to see who sponsored the review/study, if, in fact, sponsorship has been declared.17

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