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Confidence Intervals – CASP

The p-value gives no direct indication of how large or important the estimated effect size is. So, confidence intervals are often preferred.

| 0 Comments | Evaluated

Know Your Chances

This book has been shown in two randomized trials to improve peoples' understanding of risk in the context of health care choices.

| 0 Comments | Evaluated
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Bias

A University of Massachusetts Medical School text on biases.

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Harm

A University of Massachusetts Medical School text on adverse effects of treatments.

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Therapy

A University of Massachusetts Medical School text discussing the strengths and limitations of different measures of the effects of treatment

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The DIY evaluation guide

The Educational Endowment Foundation’s DIY Evaluation Guide for teachers introduces the key principles of educational evaluation.

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Animal Studies

‘Ask for Evidence’ information about the relevance and limitations of animal studies for promoting human health.

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What are the results?

A Duke Univ. tutorial explaining how to address the questions: How large was the treatment effect? What was the absolute risk reduction?

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Sunn Skepsis

Denne portalen er ment å gi deg som pasient råd om kvalitetskriterier for helseinformasjon og tilgang til forskningsbasert informasjon.

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DRUG TOO

James McCormick with another parody/spoof of the Cee Lo Green song ‘Forget You’ to prompt scepticism about many drug treatments.

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Dodgy academic PR

Ben Goldacre: 58% of all press releases by academic institutions lacked relevant cautions and caveats about the methods and results reported

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How do you regulate Wu?

Ben Goldacre finds that students of Chinese medicine are taught (on a science degree) that the spleen is “the root of post-heaven essence”.

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Screen test

Ben Goldacre notes that even if people realize that screening programmes have downsides, people don’t regret being screened.

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The certainty of chance

Ben Goldacre reminds readers how associations may simply reflect the play of chance, and describes Deming’s illustration of this.

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Publish or be damned

Ben Goldacre points out the indefensible practice of announcing conclusions from research studies which haven’t been published.

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Weasels Are on the Loose

Weaseling is the use of certain words to weaken a claim, so that the author can say something without actually saying it and avoid criticism

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How Science Works

Definitions of terms that students have to know for 'How Science Works' and associated coursework, ISAs, etc

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The Systematic Review

This blog explains what a systematic review is, the steps involved in carrying one out, and how the review should be structured.

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The Bias of Language

Publication of research findings in a particular language may be prompted by the nature and direction of the results.

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Defining Bias

This blog explains what is meant by ‘bias’ in research, focusing particularly on attrition bias and detection bias.

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Balancing Benefits and harms

A blog explaining what is meant by ‘benefits’ and ‘harms’ in the context of healthcare interventions, and the importance of balancing them.

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Data Analysis Methods

A discussion of 2 approaches to data analysis in trials - ‘As Treated’, and ‘Intention-to-Treat’ - and some of the pros and cons of each.

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Defining Risk

This blog defines ‘risk’ in relation to health, and discusses some the difficulties in applying estimates of risk to a given individual.

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Cancer Screening Debate

This blog discusses problems that can be associated with cancer screening, including over-diagnosis and thus (unnecessary) over-treatment.

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P Values – CASP

Statistical significance is usually assessed by appeal to a p-value, a probability, which can take any value between 0 and 1 (certain).

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Testing Treatments

Testing Treatments is a book to help the public understand why fair tests of treatments are needed, what they are, and how to use them.

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Eureka!

Cherry picking the results of people in sub-groups can be misleading.

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Composite Outcomes

Fair comparisons of treatments should measure important outcomes and avoid dependence on surrogate outcome measures.

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Biomarkers unlimited

Fair comparisons of treatments should measure important outcomes and avoid dependence on surrogate outcome measures.

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Goldilocks

Cartoon and blog about how poorly performed systematic reviews and meta-analyses may misrepresent the truth.

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Cherry Picking

Cherry-picking results that only support your own conclusion may mean ignoring important evidence that refutes a treatment claim.

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Forest Plot Trilogy

Synthesising the results of similar but separate fair comparisons (meta-analysis) may help by yielding statistically more reliable estimates

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False Precision

The use of p-values to indicate the probability of something occurring by chance may be misleading.

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Does it work?

People with vested interests may use misleading statistics to support claims about the efects of new treatments.

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Alicia

Earlier testing is not always better, and can lead to overdiagnosis and overtreatment.

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Peer-Review

Even quality control steps, such as peer-review, can be affected by conflicts of interest.

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Gertrud

Exaggeration and hopes or fears can lead to unrealistic expectations about treatment effects.

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Soy Lattes

Just because two things are associated, doesn't mean one thing caused the other.

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CEBM – Study Designs

A short article explaining the relative strengths and weaknesses of different types of study design for assessing treatment effects.

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DISCERN online

A questionnaire providing a valid and reliable way of assessing the quality of written information on treatment choices.

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Means vs. Medians

Keith Bower’s 3-min video explaining how means (averages) and medians can be presented misleadingly.

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Mega-trials

In this 5 min audio resource, Neeraj Bhala discusses systematic reviews and the impact of mega-trials.

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The placebo effect

A video by NHS Choices explaining what the placebo effect is, and describing its role in medical research and the pharmaceutical industry.

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1 – New, but is it better?

In this Chapter: Introduction (this page) Thalidomide Vioxx Avandia Mechanical heart valves Herceptin References (Section 1) Key points Testing new […]

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Who has diabetes?

So how do we decide who has diabetes? When I was in medical school, our numerical rule was this: if […]

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From person to patient

Screening will inevitably turn some people who test ‘positive’ into patients – a transformation not to be undertaken lightly. ‘If […]

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Mother’s kiss

Low-tech approaches can have dramatic effects too. Young children sometimes place small objects – plastic toys or beads, for example […]

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Breast cancer

The treatment of breast cancer provides another example of professional uncertainty. There is considerable variability in the use of surgery, […]

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Mutilating surgery

Until the middle of the 20th century, surgery was the main treatment for breast cancer. This was based on the […]

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Pester power and new drugs

‘New drugs by their very nature are incomplete products, as full information about their safety, effectiveness and impact on costs […]

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A key partnership

‘People-focused research in the NHS simply cannot be delivered without the involvement of patients and the public. No matter how […]

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Dodgy, devious and duped?

Writing a light-hearted article for a Christmas edition of the British Medical Journal, two researchers created a spoof company called […]

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Stroke

Another example of unnecessary research, yet again because the results of preceding studies had not been gathered together and analyzed, […]

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Psychiatric disorders

Regrettably, research is not always well done or relevant. Take the example of a distressing condition known as tardive dyskinesia. […]

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HIV infection in children

The results of good research are also making a real difference to children infected with HIV (human immunodeficiency virus), the […]

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Pre-eclampsia in pregnant women

Another outstanding example of good research concerns pregnant women. Worldwide, about 600,000 women die each year of pregnancy-related complications. Most […]

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Stroke

Stroke is a leading cause of death and long-term disability. The death rate is between one in six and two […]

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Biased ethics

‘If a clinician tries a new therapy with the idea of studying it carefully, evaluating outcomes, and publishing the results, […]

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In an ideal world

‘In an ideal world, wherever possible, we could be gathering anonymised outcome data and comparing this against medication history, making […]

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Information and consent

Requirements relating to provision of information and consent for studies are one of the ways in which the regulatory system […]

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Marketing-based medicine

‘Internal documents from the pharmaceutical industry suggest that the publicly available evidence base may not accurately represent the underlying data […]

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Why did you start?

‘Few principles are more fundamental to the scientific and ethical validity of clinical research than that studies should address questions […]

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Is one study ever enough?

The simple answer is ‘hardly ever’. Very seldom will one fair treatment comparison yield sufficiently reliable evidence on which to […]

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The Yellow Card Scheme

The Yellow Card Scheme was launched in Britain in 1964 after the thalidomide tragedy highlighted the importance of following up […]

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Believing is seeing

The British doctor Richard Asher noted in one of his essays for doctors: ‘If you can believe fervently in your […]

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Comparing like with like

In this sub-section Comparisons are key (this page) Treatments with dramatic effects Treatments with moderate but important effects Comparisons are […]

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When practitioners disagree

In this sub-section Introduction (this page) Caffeine for breathing problems in premature babies Antibiotics in pre-term labour Breast cancer Introduction […]

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The Screening Circus

In 2009, a recently retired professor of neurology with a long-standing interest in stroke prevention learnt that neighbours had received […]

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Selling screening

‘Selling screening can be easy. Induce fear by exaggerating risk. Offer hope by exaggerating the benefit of screening. And don’t […]

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Is anyone normal?

Whole-body CT scans Among the tests on offer at private clinics are whole-body computed tomography (CT) scans to look at […]

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Diethylstilboestrol

At one time, doctors were uncertain whether pregnant women who had previously had miscarriages and stillbirths could be helped by […]

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Herceptin

Commercial companies are not alone in trumpeting the advantages of new treatments while down-playing drawbacks. Professional hype and enthusiastic media […]

| 1 Comment
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Mechanical heart valves

Drugs are not the only treatments that can have unexpected bad effects: non-drug treatments can pose serious risks too. Mechanical […]

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Avandia

2010 saw another drug – rosiglitazone, better known by the trade name Avandia – hitting the headlines because of unwanted […]

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Vioxx

Although drug-testing regulations have been tightened up considerably, even with the very best drug-testing practices there can be no absolute […]

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Thalidomide

Thalidomide is an especially chilling example of a new medical treatment that did more harm than good. [1] This sleeping […]

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