In Reply: Dr Shah suggests that systematic
reviews of observational studies provide better evidence than single randomized
trials. We disagree strongly. Shah's proposal would, for instance, rank a
meta-analyses of observational studies of hormone replacement therapy1 (which suggested a 50% reduction in relative risk
of coronary events) higher than the Heart and Estrogen/progestin Replacement
Study (HERS) RCT,2 which found no effect
of hormone replacement therapy for secondary prevention of coronary events.
We would rank the HERS RCT higher and, pending further RCT evidence, would
not recommend hormone replacement therapy to women to decrease their risk
of cardiovascular events. When consistent biases exist in observational studies
(such as the tendency for women with lower cardiovascular risk to receive
hormone replacement therapy), a meta-analysis offers no protection.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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