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Specific guide to this web site for:

 1.  Medical School
      Educators 
      in Statistics

 2.  Medical Students

 3.  Science media writers

 4.  High School & College
     Statistic Teachers

   Misadventures:

1. Harvard led MI study

2. JACC study 
   (J. of Amer. Coll.
   Cardio.)

3. NEJM cath study

4. Amer. J. of Cardio.
    review of literature

5. ALLHAT
    controversy 

6. Oat bran study

7. Pregnancy & Alcohol

8. Are Geminis really
    different?
      
9. Columbia 'Miracle' Study  
                                                 

Additional Topics:

Celebrex

Limitations of Meta-Analyses

Large Randomized Clinical Trials

Tale of Two Large
Trials

Advocate meta-analyses

Network meta-analyses

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"Speculation into the future" regarding an influential trial that made recommendations what trial data warranted in regards to initial treatment of hypertension

This example concerned the 2003 ALLHAT trial which studied different hypertensive drug strategies for the treatment of elevated blood pressure. The authors of the trial then formulated conclusions that extended beyond what was appropriate for the trial’s outcome data. 

This study continues to have an impact because of the large size of this trial and the fact that the investigators were influential in formulating the national blood pressure guidelines in the United States. However, 10 years from now, it is likely the conclusion of this article that a single type of antihypertensive drug is the best initial drug for hypertension, will be largely replaced by other viewpoints. This alternative viewpoint already held by many current experts in hypertension is that blood pressure treatment requires administration with particular combinations of blood pressure medicines which need to be tailored to the individual patient response rather than a single blood pressure agent being the "best" initial treatment for all patients. Also, certain subgroups of patients with hypertension, such as those with significantly impaired heart function, as an example, have specific hypertensive medications best used for initiating treatment. (Maybe in the future, a “best” single hypertensive medication will be discovered, but that time has certainly not arrived.) 

On a more optimistic note, there appears to be a possible trend in academic circles to advocate a conservative set of conclusions for large clinical trials rather than inappropriate conclusions which aggressively extend beyond the merits of the data presented in the study. If this trend continues and is incorporated by the editors of the major journals, the medical literature will be well served.

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