Hi Rakesh:
From the abstract, it appears to be an interesting piece of work. I
only had a chance to read the abstract of the article, and all I write
now is based on that abstract. I ought to take a look at the full
text. That said, this segment of the abstract kind of jumped up from
the page:
"The present EBM literature neglects a lot of events it doesn't
believe to be statistically significant and perhaps here is an area
that needs to be improved on – it assumes that because associations
are demonstrated between interventions and outcomes in
RCTs/meta-analysis, these associations are linear and causal in the
real world. While they may be demonstrated repeatedly in highly
controlled environments, in the real 'uncontrolled' world of clinical
practice with real people, their validity breaks down."
I often see the term "statistically significant" used loosely, as if
that phrase has a universal meaning to everyone. What is "significant"
about something being statistically significant is almost always very
unclear. As far as I can say, EBM oriented my views to write something
like "p= 0.03" as opposed to expressions like "statistically
significant". Is the apparent criticism, that EBM places more value on
p values rather than the substantive arguments, fair?
The apparent skepticism that the authors express here of EBM being
negligent of null studies may stem from the fact that a lot of gray
literature are out there, and studies that fail to disprove the null
are deemed to have less chance of being published in prolific journals
in general, and get promoted (publication bias?). I suspect reality is
more complicated than that, and market forces/economic incentives may
have some roles to play. For instance, if a company that manufactures
and markets cellular phones funds a study on cellphones and risk of
tumors, would it not be more likely for them to see that null results
get highlighted? When financial, as opposed to moral incentives are at
stake, they (albeit subtly) influence a lot of literature based
clinical decision making. My point being, what studies go (or sit out)
into that decision making matrix may not have to deal entirely with
EBM.
For the sake of more informed discussions, I'd encourage you to share
the pdf with those of us who are interested but cannot access the full
text version.
Best wishes,
Arin Basu
On 8/9/07, Rakesh Biswas <[log in to unmask]> wrote:
> Wanted to share this article from our institute written in collaboration
> with colleagues from
> other institutes.
> Click on:
> http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2753.2007.00837.x
>
> It begins as an autoethnographic reflection of an individual physician
> exploring the relationship between his largely qualitative day to day
>
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