ETHER 29 Jan 2016

His Greatness,NSY

I hate stats

Medutainment

#ih8stats

ih8stats

https://www.sli.do/event/qt6qioy3/wall

Why use statistics?

But is the Truth true?

An Example

Asiana Flight 214

AmTrak

Why not ask bus drivers instead?

Type of Paper

Intervention

Drug Trial

RCT Observational

Case reportCase series

Case control

Cohort

Meta-analysisSystematic Review

Type of Paper

Intervention

Drug Trial

RCT Observational

Case reportCase series

Case control

Cohort

Meta-analysisSystematic Review

What is the question?

Why this question?

How to answer this question?

Inclusion / Exclusion

Methodology

Actual stats calculation

Conclusions and relevance

RCT - Intervention

Interim analysis

No control group.

Significant conflict of interest

COD: Fudgy terminology

Small numbers

Politics

Fame

Money

True Truth

Define a “good” journal

Industry sponsored trialBMJ 7%

NEJM 32%

CitationsIndustry sponsored > other source of funding

Reduction in Impact Factor1%15%

Reprints

Oct 2010

Nov 2009

May 2015

…half baked ……tendentious …

…ill advised …

Politics

Fame

Money

True Truth

https://www.sli.do/event/qt6qioy3/wall

What to make of negative studies?

risk

of d

eath

untreated risk of death

redu

ctio

n of

risk

of d

eath

untreated risk of death redu

ctio

n of

risk

of d

eath

untreated risk of death

A B C

redu

ctio

n of

risk

of d

eath

untreated risk of death

adverse effectsris

k of

dea

th

untreated risk of death

treatmentris

k of

dea

th

untreated risk of death

no treatment

ABC

Why ask this question?How to answer this question?

Is meta-analysis the right method to answer this question?

Meta-analysis

What’s the result?How do we know the results

valid?

Meta-analysis

G.I.G.O

Garbagedata

Garbageresult

Garbage analysis

Where How Quality

DataReproducible Robust

Meta-analysisHow do we know the results

valid?

Search databases / termsIndependent extractionPredefined data formAgreeing how to disagree

Meta-analysisHow do we know the results

valid?

Publication biasFunnel Plot

DataReproducible Robust

Problem of negative studies

“Perfect”data

Garbageresult

Garbage analysis

Observation vs intervention

Heterogeneity

Random vs fixed effect

Sensitivity Analysis

Meta-analysis

Meta-analysis

Heterogeneity - I2

Lower = less heterogeneityHigher = more heterogeneity

describes the percentage of variation across studiesthat is due to heterogeneity rather than chance

Meta-analysis

Random vs Fixed Effect

One true effect size shared by all the studies

True effect vary so each study estimates a different effect size(when significant

heterogeneityexist)

Sensitivity Analysis

Meta-analysis

Performing analysis with different assumptionsto see if result remains the same

How to apply the results?

“Perfect”data Result“Perfect”

analysis

Meta-analysis

Take home messages

Medutainment is realand here to stay.

Paper critique is about logic.

If you are worried about Exit Paper critique,you are probably suffer from imposter syndrome.

PerfectExcellence

Good enough

@HonLiangTantanhonliang@gmail.com

tan.hon.liang@singhealth.com.sg

https://www.sli.do/event/qt6qioy3/infographic