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Editor's Correspondence |

Comparing Apples to Oranges in Meta-analysis Studies—Reply

David Reiter, MD, DMD
Arch Facial Plast Surg. 2007;9(2):140-141. doi:10.1001/archfaci.9.2.140.
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In reply

We are grateful to Rhee for his interest and enthusiasm, and we agree with many of his points. But we must respectfully disagree on a few key ones, which we will address in the order in which he introduces them.

Our null hypothesis is not that “a keloid has a 50% likelihood of improvement by chance alone.” It might well be stated as the presumption that an observer has an even chance of reporting that a keloid improved after treatment if he or she did not provide that treatment. We believe this because there is a plethora of published treatment methods that subjectively suggest dramatic short-term response (based largely on observation and questions about patient satisfaction), but all have failed to achieve gold standard status. Results considered good when observed in the treatment cohort of a study of one management method are considered poor in the control cohort of a study advocating another treatment. And neither method is widely adopted.

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