Many systematic reviews are inconclusive and reinforce the message that there is

clinical uncertainty. Phil Alderson and Ian Roberts argue that journals should make a
point of publishing such reviews rather than waiting for reviews that show marked
benefit or harm. Some experts disagree, however, but we failed to persuade them to
commit their views to print.

Studies with dramatic findings make interesting reading. Journal editors

understandably want to publish articles that their readers will enjoy. This is one
cause of publication bias, where research with less dramatic results tends to be
published in journals with a smaller circulation, if indeed it is published at all.
Systematic reviews are no less vulnerable to this bias than other types of research.
Should journals resist this pressure and make a point of publishing systematic
reviews even if all they show is continuing clinical uncertainty? The answer will
depend on the importance we attach to demonstrating uncertainty in medical
practice.