After all the cochrane group says that in regard to establishing scientific truth the "systematic review of all relevant randomized clinical trials is the highest level of evidence."
What seems to be a different view is that the following characterization of the MA by Dr.Steven Goodman who explains that a MA is basically an observational trial in which the subjects are themselves clinical trials. In the traditional hierarchic of clinical evidence observational trials are not considered the top of the pyramid.
so what is it-the highest order of evidence or merely a lowly observational study?
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