Empirical Evaluation of Very Large Treatment Effects of Medical Interventions

Pereira, Tiago; Horwitz, Ralph I.; Ioannidis, John P. A.

doi:10.1001/jama.2012.13444

Cited by 215 publications

(178 citation statements)

References 47 publications

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“…Djulbegovic 74 extended this list to nearly 50 examples. Yet what must be acknowledged is that this set of interventions is a tiny fraction of all medical practices: as there are at least 80 000 practices, 5 50 practices account for just 0.06% of medical interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Our results provide a reassuring note. Few medical practices have large treatment effects, 5 and even practices believed to be parachutes often are not.…”

Section: Discussionmentioning

confidence: 99%

“…Empirical analyses show that few medical practices offer so large a magnitude of benefit. For instance, in a review of over 80 000 medical Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes practices from the Cochrane database, Pereira and colleagues 5 found only 1 medical practice that reliably had a large effect on overall mortality, and the absolute risk reduction (ARR) of this practice was about 33%. 6 Despite the limits to the parachute analogy, the article by Smith and Pell 1 has gained popularity in the medical community and is often used to criticize the need for RCTs of a specific practice.…”

mentioning

confidence: 99%

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Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes

Hayes¹,

Kaestner

Mailankody

et al. 2018

CMAJ Open

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Background:In a 2003 paper in BMJ, the authors made the tongue-in-cheek observation that there are no randomized controlled trials (RCTs) of parachutes. This paper has been widely read, cited and used to argue that RCTs are impractical or unnecessary for some medical practices. We performed a study to identify and evaluate claims that a medical practice is akin to a parachute. Methods:Using Google Scholar, we identified all citations to the 2003 paper. We searched for claims that a specific practice was akin to a parachute. For each practice, we identified the desired outcome of the practice, and searched Google Scholar and ClinicalTrials.gov for RCTs that were conducted, ongoing, halted, planned or unpublished.Results: Of 822 articles citing the original paper, 35 (4.1%) argued that a medical practice was akin to a parachute. Eighteen of the 35 (51%) concerned mortality or live birth, and 17 (49%) concerned a lesser outcome. For 22 practices (63%), we identified 1 or more RCTs: in 6 cases (27%), the trials showed a statistically significant benefit of the practice; in 5 (23%), the trials rejected the practice; in 5 (23%), the trials had mixed results; in 2 (9%), the trials were halted; and in 4 (18%), the trials were ongoing. Effect size was calculated for 5 of the 6 practices for which RCTs gave positive results, and the absolute risk reduction ranged from 11% to 30.8%, corresponding to a number needed to treat of 3-9.Interpretation: Although there is widespread interest regarding the BMJ paper arguing that randomized trials are not necessary for practices of clear benefit, there are few analogies in medicine. Most parachute analogies in medicine are inappropriate, incorrect or misused. Abstract Research OPEN Research E32CMAJ OPEN, 6(1)

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Section: Discussionmentioning

confidence: 99%

“…Our results provide a reassuring note. Few medical practices have large treatment effects, 5 and even practices believed to be parachutes often are not.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes

Hayes¹,

Kaestner

Mailankody

et al. 2018

CMAJ Open

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“…The latter observation is most pertinent for the biomedical research realm in which "empirical evidence suggests that most medical intervention effects are small or modest" (Pereira, Horwitz, and Ioannidis 2012). This maxent prior avoids Bartlett's and the information paradoxes (Wang and Liu 2016).…”

Section: Bayesian Hypothesis Testing Frameworkmentioning

confidence: 99%

Bayesian Analysis on a Noncentral Fisher–Student’s Hypersphere

Blanc

2018

The American Statistician

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Fisher succeeded early on in redefining Student's t-distribution in geometrical terms on a central hypersphere. Intriguingly, a noncentral analytical extension for this fundamental Fisher-Student's central hypersphere h-distribution does not exist. We therefore set to derive the noncentral h-distribution and use it to graphically illustrate the limitations of the Neyman-Pearson null hypothesis significance testing framework and the strengths of the Bayesian statistical hypothesis analysis framework on the hypersphere polar axis, a compact nontrivial one-dimensional parameter space. Using a geometrically meaningful maximal entropy prior, we requalify the apparent failure of an important psychological science reproducibility project. We proceed to show that the Bayes factor appropriately models the two-sample t-test p-value density of a gene expression profile produced by the high-throughput genomic-scale microarray technology, and provides a simple expression for a local false discovery rate addressing the multiple hypothesis testing problem brought about by such a technology.

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“…[11] An analysis of highly cited trials published in the three journals with the highest impact factors (New England Journal of Medicine, Lancet, Journal of the American Medical Association) and those with an impact factor greater than seven, showed that 30% of trials initially reporting highly significant positive findings were found in subsequent studies to either overestimate treatment effect or show no benefit. [15,16] The effect of funding extends beyond drug or equipment trials. Guidelines and consensus statements by panels of experts are frequently supported by industry, and the members of such panels may have financial affiliations with the sponsoring company.…”

Section: Sponsorship By For-profit Organisationsmentioning

confidence: 99%