When Science Challenges Our Long-Held Assumptions About the Robustness of Evidence for Standard of Care.

In this issue of the Journal, we publish two letters pertaining to the article "Systematic Review and Meta-analysis: Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents" by Uhre et al. Their protocol employed the Cochrane Handbook for Systematic Reviews of Interventions to evaluate risk of bias (selection, performance, detection, attrition, and reporting biases) in the included 25 trials, contacting trial authors to obtain missing data where possible. They controlled for random errors owing to sparse data or multiple testing using Trial Sequential Analysis and evaluated the certainty of the evidence using the Grading of Recommendations Assessment Development and Evaluation approach. They concluded that cognitive-behavioral therapy (CBT) (versus no intervention) is effective for pediatric obsessive-compulsive disorder (OCD), but that the certainty of evidence was low or very low for all outcomes and that moderator analyses could often not be completed for lack of data. The authors made the point that blinding is always possible, even in CBT trials.