If used appropriately, meta-analysis is a powerful tool for deriving meaningful conclusions from data and can help prevent errors in interpretation. However, there are situations in which a meta-analysis can be more of a hindrance than a help.
A common criticism of meta-analyses is that they ‘combine apples with oranges’. If studies are clinically diverse then a meta-analysis may be meaningless, and genuine differences in effects may be obscured.A particularly important type of diversity is in the comparisons being made by the primary studies. Often it is nonsensical to combine all included studies in a single meta-analysis: sometimes there is a mix of comparisons of different treatments with different comparators, each combination of which may need to be considered separately. Further, it is important not to combine outcomes that are too diverse. Decisions concerning what should and should not be combined are inevitably subjective, and are not amenable to statistical solutions but require discussion and clinical judgement. In some cases consensus may be hard to reach.
Meta-analyses of studies that are at risk of bias may be seriously misleading.If bias is present in each (or some) of the individual studies, meta-analysis will simply compound the errors, and produce a ‘wrong’ result that may be interpreted as having more credibility.
Finally, meta-analyses in the presence of serious publication and/or reporting biases are likely to produce an inappropriate summary.