The latest salvo in the worm wars brings out big guns:
There is consensus that the relevant deworming drugs are safe and effective, so the key question facing policymakers is whether the expected benefits of MDA exceed the roughly $0.30 per treatment cost. The literature on long run educational and economic impacts of deworming suggests that this is the case. However, a recent meta-analysis by Taylor-Robinson et al. (2015) (hereafter TMSDG), disputes these findings. The authors conclude that while treatment of children known to be infected increases weight by 0.75 kg (95% CI: 0.24, 1.26; p=0.0038), there is substantial evidence that MDA has no impact on weight or other child outcomes. We update the TMSDG analysis by including studies omitted from that analysis and extracting additional data from included studies, such as deriving standard errors from p-values when the standard errors are not reported in the original article. The updated sample includes twice as many trials as analyzed by TMSDG, substantially improving statistical power. We find that the TMSDG analysis is underpowered: it would conclude that MDA has no effect even if the true effect were (1) large enough to be cost-effective relative to other interventions in similar populations, or (2) of a size that is consistent with results from studies of children known to be infected.
…Applying either of two study classification approaches used in previous Cochrane Reviews (prior to TMSDG) also leads to rejection at the 5% level.
…Under-powered meta-analyses (such as TMSDG) are common in health research, and this methodological issue will be increasingly important as growing numbers of economists and other social scientists conduct meta-analysis.
I think the most confident prediction that can be made is this: a new meta-analysis by TMSDG or someone will argue something different, a response analysis will find statistical flaws, and so on, until it doesn’t matter anymore.
I say “until it doesn’t matter anymore” because I recently spoke to a large charitable organization who basically said, “yes we could fund more long term studies looking at the economic impacts of deworming, but by the time the results arrived in 10 years it wouldn’t matter anymore because we’re probably going to eliminate worms in those areas in 10 years anyways.” Hm.
At current publishing speeds, we can expect at least 10 more battling meta-analyses before then. I’m sitting on the sidelines from here on out. Pass the popcorn.