Saturday, August 11, 2012

The non-statistical significance of the anecdote

Compelling anecdotes - "It saved my life!" - can drive us so wildly astray. Rigorous research is the antidote, but it often doesn't feel like it has an even chance! Especially when it comes to screening and "preventive" medicine (conventional and complementary).

A wonderful book by Margaret McCartney is a great example of what we need so much: a combination of beautiful storytelling with reliable research. It charts the paths that lead to health care that does more harm than good - over-treating the (well-off) worried well while the (less well-to-do) sick wait. This is The Patient Paradox, where "clinics and waiting rooms are jammed with healthy people" but there's not enough care for the sick.

Margaret blogs here and tweets here.

Friday, August 3, 2012

Drugs go head-to-head at the Pharma Olympics

At the Olympics, humans try to go "higher, faster, stronger" - and achieve their personal best. The bar is constantly raised. Drugs don't have to be better to cross the line, though: they can get by on what's called non-inferiority or equivalence trials. "No worse" (more or less) can be good enough.

Some drugs are now only loosely possibly non-inferior to other non-inferior drugs - several degrees removed from proven superior to doing nothing. Add the increasing reliance on shortcut measures of what works, and there's a real worry that for drugs, the performance bar is being lowered.

If you want to read about the differences between traditional randomized controlled trials that can show superiority and their non-inferiority and equivalence cousins, click on the PDF here at the CONSORT website.