Accumulating research: a systematic account of how cumulative meta-analyses would have provided knowledge, improved health, reduced harm and saved resources

BACKGROUND: "Cumulative meta-analysis" describes a statistical procedure to calculate, retrospectively, summary estimates from the results of similar trials every time the results of a further trial in the series had become available. In the early 1990 s, comparisons of cumulative meta-analyses of treatments for myocardial infarction with advice promulgated through medical textbooks showed that research had continued long after robust estimates of treatment effects had accumulated, and that medical textbooks had overlooked strong, existing evidence from trials. Cumulative meta-analyses have subsequently been used to assess what could have been known had new studies been informed by systematic reviews of relevant existing evidence and how waste might have been reduced.

METHODS AND FINDINGS: We used a systematic approach to identify and summarise the findings of cumulative meta-analyses of studies of the effects of clinical interventions, published from 1992 to 2012. Searches were done of PubMed, MEDLINE, EMBASE, the Cochrane Methodology Register and Science Citation Index. A total of 50 eligible reports were identified, including more than 1,500 cumulative meta-analyses. A variety of themes are illustrated with specific examples. The studies showed that initially positive results became null or negative in meta-analyses as more trials were done; that early null or negative results were over-turned; that stable results (beneficial, harmful and neutral) would have been seen had a meta-analysis been done before the new trial; and that additional trials had been much too small to resolve the remaining uncertainties.

CONCLUSIONS: This large, unique collection of cumulative meta-analyses highlights how a review of the existing evidence might have helped researchers, practitioners, patients and funders make more informed decisions and choices about new trials over decades of research. This would have led to earlier uptake of effective interventions in practice, less exposure of trial participants to less effective treatments, and reduced waste resulting from unjustified research.

Corporate Ownership, Control, and Firm Performance in Victorian Britain

Scholars have long debated whether ownership structure matters for firm performance. The standard view with respect to Victorian Britain is that family-controlled companies had a detrimental effect on operating profit and shareholder value. Here, we examine this view using a hand-collected corporate ownership dataset. Our main finding is that it was not necessarily the broad structure of corporate ownership that mattered for performance, but whether family blockholders had a governance role. Large active blockholders tended to increase operating performance, implying that they reduced managerial agency problems. In contrast, we find that directors who were independent of large family owners were more likely to increase shareholder value.

The Legitimacy of Subsidiary Issue Selling: Balancing Positive & Negative Attention from Corporate Headquarters

We consider how in issue selling, subsidiaries draw on different forms of legitimacy to attract corporate headquarters’ (CHQ) positive attention and minimise negative CHQ attention. Through case study evidence, we find that directing CHQ attention to subsidiary issues needs to be executed as a balancing act through forms of subsidiary legitimacy, namely; the personal legitimacy of key individuals at the subsidiary; consequential legitimacy vis-à-vis peer subsidiaries; and linkage legitimacy in the local environment. We develop a typology of subsidiary issue-selling roles and illustrate how negative CHQ attention results from a failure to legitimise issue selling.

Minimising harm from alcohol misuse: Challenges to the development of effective policy

Successive substance misuse strategies in Northern Ireland and elsewhere have
been underpinned by the goal of minimising the harm accruing from the use of alcohol and other drugs. However, what it means for a person’s alcohol use to cause harm is an evolving concept. As the understanding of harm changes, the type of evidence needed to estimate the scale of harm and to evaluate the success of a given initiative changes also.
This paper does three things. We first highlight a recent model by Laslett and
colleagues for estimating the harm of one individual’s alcohol use to other individuals, the centrepiece of a report to the Alcohol Education and Research Foundation (AERF) in 2010. This model has been hugely influential in identifying areas where harms from alcohol use accrue and in attempting to quantify those harms (e.g. the cost of injuries inflicted during intoxication). We suggest three ways in which this model could be improved by accounting for: (a) the influence of one individual’s drinking on the drinking behaviour of their peers; (b) the level of use which triggers a given harm; and (c) the degree of time-lag in each of
the domains of harm.
Secondly, we explore specific challenges to developing effective policy on
adolescents’ drinking behaviours, drawing on research which specifically elicits the perspectives of young people on why they drink.
Thirdly, we examine the relative harms of allowing moderate levels of drinking
among mid-adolescents versus promoting zero use up until late adolescence.