With notable negative impacts in clinical research, large numbers of studies simply replicate findings that have previously been confirmed. Caroline Blaine, Klara Brunnhuber and Hans Lund, suggest that much of this waste could be averted with a more structured and careful approach to systematic reviews and propose Evidence-Based Research as a framework for achieving this.

Meta-research (research on research) has shown that many unnecessary studies could have been avoided, if a systematic review had been conducted during the planning phase to flag that no new research was needed. Failing to base new scientific studies on earlier results, especially in medical research, exposes participants to unnecessary research. This is not just wasteful, but is unethical, potentially harmful and limits funding for important and relevant research.

Cumulative meta-analysis, in which studies are added in order of publication date to show the overall result as each new study contributes to the knowledge base, is a research tool that can be used to demonstrate when confirmatory studies are no longer required. These cumulative meta-analyses have over time shown the same picture of waste in many cases. For example:

• In 1992 Lau et al. published a cumulative meta-analysis showing by 1977 enough studies had been conducted to conclude that intravenous streptokinase preserves left ventricular function in patients with acute myocardial infarction. Nevertheless, from 1977 to 1988 more than 30,000 patients were involved in unnecessary placebo-controlled randomised controlled trials (RCTs) of intravenous streptokinase.

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