What if there is no clear evidence one way or the other of the intervention under review?

I would like to run past Consumers a problem I have had with comments that have turned up on the Internet that have been taken out of context. I personally have never put anything on the net. Also I have never seen the following subject raised in discussion in Consumer circles when review results are not clear-cut.

I am the lead person of the review Speleotherapy for Asthma, Cochrane Collaboration Review, Beamon, S., Falkenbach, A., Fainburg, G., Linde, K., published on CD Rom, Cochrane Library, 1999. Updated regularly. I questioned this matter with Airways Entity years ago and below are the relevant comments.

'When referring to speleotherapy reviews where there is no clear evidence to support the use of an intervention. It is a complex methodological issue - just because a review does not provide evidence to support the use of an intervention readers should not conclude that the intervention is necessarily unhelpful. One can make fairly strong conclusions from a meta-analysis that demonstrates a clear treatment effect, but we can never draw conclusions (in favour of either direction) from a meta-analysis that demonstrates no clear treatment effect.

The history of evidence based medicine is littered with examples of people wrongly concluding that an absence of evidence is evidence of no benefit ...’    

This is not true as not proved either way.

‘... A review can give you a clear answer only if there are high quality clinical trials that present us with that evidence.’'

There was, and still is, a PAUCITY of speleotherapy systematic randomised controlled trials.

I don't think these problems are raised enough or explained and I would be interested in what other Consumers think.

* Speaking as a former chronic asthmatic I personally believe in speleotherapy treatment. I undertook such therapy in both Romania (1995) and Poland (1997), then was completely free of asthma for five years and only experience mild symptoms occasionally since (2011). I realise of course I am prejudiced !

Sylvia P. Beamon (Airways Entity)

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