Publication bias is the tendency for certain kinds of studies, typically those showing a significant positive result in a clinical trial or an observational study, to receive more favorable publication decisions than equally well-conducted studies that report a negative or null result.1- 4 Authors, editors, and peer reviewers all participate in this favoritism toward publication of positive results. An obvious outcome of the bias toward overpublication of positive results is that many treatments or exposures are overrated in the published literature. Some critics have gone so far as to claim that publication bias results in “most published research findings” being “false.”5 Although most researchers, reviewers, and editors would probably believe that such a claim is far too harsh, an unquestioned result of the overwhelming bias to publish mostly positive studies is that subsequent meta-analyses are distorted and result in promoting existing scientific biases. The Cochrane Collaboration admits the existence of this bias in the systematic reviews it publishes and suggests attenuating strategies such as probability models and funnel plot techniques.6
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Figure 20.1-1. Treatment Effectiveness and Publication Bias
Figure 20.1-2A. No Publication Bias
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