This Article Full Text (PDF) All Versions of this Article: 0962280207080641v1 17/3/253    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Moyé, L. A Search for Related Content PubMed PubMed Citation Articles by Moyé, L. A Social Bookmarking                         What's this?

Disciplined analyses in clinical trials: the dark heart of the matter

Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA, lemuel.a.moye{at}uth.tmc.edu

Clinical research analyses must balance the desire to `learn all that is learnable' from the database with the observation that sample-based data commonly lead to conclusions that are perfectly correct for the sample, but wholly incorrect for the population from which the data were based.

Investigators who defend exploratory analyses as reliable, misuse important tools that have taken over three hundred years to develop. Statistical estimators in clinical trials function appropriately when they incorporate random data that is gathered in response to a "xed research question. Their prediction ability degrades rapidly when the selection of the research question is itself random, that is, left to the data. Operating like blind guides, these estimators mislead the medical community about what it would see in the population, based on sample observations. The result is a wavering research focus, leaping from one provocative but misleading "nding to the next on the powerful waves of sampling error. Therefore, a primary purpose of the prospective design is to "x the research questions prospectively, thereby anchoring the analysis plan.

Prospective statements of the research questions and rejection of tempting databased changes to the protocol preserve the best estimates of effect sizes, standard errors, con"dence intervals and p-values. Embracing these principles promotes the prosecution of a successful research program, that is, the construction and protection of a research environment that permits an objective assessment of the therapy or exposure being studied. If there is any "xed star in the research constellation, it is that sample-based research must be hypothesis-driven and concordantly executed to have real meaning for both the scienti"c community and the patient populations that we serve.

This version was published on June 1, 2008

Statistical Methods in Medical Research, Vol. 17, No. 3, 253-264 (2008)
DOI: 10.1177/0962280207080641


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?