Learning Resources

Learning resources are organised by Key Concepts essential to understanding fair comparisons of treatments and to help people evaluate claims about health care interventions. The Key Concepts are shown on the menu to the right.  Select a concept to find relevant resources.  You can filter what you find for your preferred format or target audience.

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Confidence Intervals – CASP

The p-value gives no direct indication of how large or important the estimated effect size is. So, confidence intervals are often preferred.

| 0 Comments | Evaluated

Know Your Chances

This book has been shown in two randomized trials to improve people's understanding of risk in the context of health care choices.

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Bias

A University of Massachusetts Medical School text on biases.

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Harm

A University of Massachusetts Medical School text on adverse effects of treatments.

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Therapy

A University of Massachusetts Medical School text discussing the strengths and limitations of different measures of the effects of treatment

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The DIY evaluation guide

The Educational Endowment Foundation’s DIY Evaluation Guide for teachers introduces the key principles of educational evaluation.

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Animal Studies

‘Ask for Evidence’ information about the relevance and limitations of animal studies for promoting human health.

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What are the results?

A Duke Univ. tutorial explaining how to address the questions: How large was the treatment effect? What was the absolute risk reduction?

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Sunn Skepsis

Denne portalen er ment å gi deg som pasient råd om kvalitetskriterier for helseinformasjon og tilgang til forskningsbasert informasjon.

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DRUG TOO

James McCormick with another parody/spoof of the Cee Lo Green song ‘Forget You’ to prompt scepticism about many drug treatments.

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Dodgy academic PR

Ben Goldacre: 58% of all press releases by academic institutions lacked relevant cautions and caveats about the methods and results reported

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How do you regulate Wu?

Ben Goldacre finds that students of Chinese medicine are taught (on a science degree) that the spleen is “the root of post-heaven essence”.

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Screen test

Ben Goldacre notes that even if people realize that screening programmes have downsides, people don’t regret being screened.

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The certainty of chance

Ben Goldacre reminds readers how associations may simply reflect the play of chance, and describes Deming’s illustration of this.

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Publish or be damned

Ben Goldacre points out the indefensible practice of announcing conclusions from research studies which haven’t been published.

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Weasels Are on the Loose

Weaseling is the use of certain words to weaken a claim, so that the author can say something without actually saying it and avoid criticism

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How Science Works

Definitions of terms that students have to know for 'How Science Works' and associated coursework, ISAs, etc

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The Systematic Review

This blog explains what a systematic review is, the steps involved in carrying one out, and how the review should be structured.

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The Bias of Language

Publication of research findings in a particular language may be prompted by the nature and direction of the results.

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Defining Bias

This blog explains what is meant by ‘bias’ in research, focusing particularly on attrition bias and detection bias.

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Balancing Benefits and harms

A blog explaining what is meant by ‘benefits’ and ‘harms’ in the context of healthcare interventions, and the importance of balancing them.

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Data Analysis Methods

A discussion of 2 approaches to data analysis in trials - ‘As Treated’, and ‘Intention-to-Treat’ - and some of the pros and cons of each.

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Defining Risk

This blog defines ‘risk’ in relation to health, and discusses some the difficulties in applying estimates of risk to a given individual.

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Cancer Screening Debate

This blog discusses problems that can be associated with cancer screening, including over-diagnosis and thus (unnecessary) over-treatment.

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P Values – CASP

Statistical significance is usually assessed by appeal to a p-value, a probability, which can take any value between 0 and 1 (certain).

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Testing Treatments

Testing Treatments is a book to help the public understand why fair tests of treatments are needed, what they are, and how to use them.

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Eureka!

Cherry picking the results of people in sub-groups can be misleading.

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Composite Outcomes

Fair comparisons of treatments should measure important outcomes and avoid dependence on surrogate outcome measures.

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Biomarkers unlimited

Fair comparisons of treatments should measure important outcomes and avoid dependence on surrogate outcome measures.

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Goldilocks

Cartoon and blog about how poorly performed systematic reviews and meta-analyses may misrepresent the truth.

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Cherry Picking

Cherry-picking results that only support your own conclusion may mean ignoring important evidence that refutes a treatment claim.

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Forest Plot Trilogy

Synthesising the results of similar but separate fair comparisons (meta-analysis) may help by yielding statistically more reliable estimates

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False Precision

The use of p-values to indicate the probability of something occurring by chance may be misleading.

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Does it work?

People with vested interests may use misleading statistics to support claims about the efects of new treatments.

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Alicia

Earlier testing is not always better, and can lead to overdiagnosis and overtreatment.

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Peer-Review

Even quality control steps, such as peer-review, can be affected by conflicts of interest.

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Gertrud

Exaggeration and hopes or fears can lead to unrealistic expectations about treatment effects.

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Soy Lattes

Just because two things are associated, doesn't mean one thing caused the other.

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CEBM – Study Designs

A short article explaining the relative strengths and weaknesses of different types of study design for assessing treatment effects.

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DISCERN online

A questionnaire providing a valid and reliable way of assessing the quality of written information on treatment choices.

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Means vs. Medians

Keith Bower’s 3-min video explaining how means (averages) and medians can be presented misleadingly.

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Mega-trials

In this 5 min audio resource, Neeraj Bhala discusses systematic reviews and the impact of mega-trials.

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The placebo effect

A video by NHS Choices explaining what the placebo effect is, and describing its role in medical research and the pharmaceutical industry.

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Who has diabetes?

So how do we decide who has diabetes? When I was in medical school, our numerical rule was this: if […]

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From person to patient

Screening will inevitably turn some people who test ‘positive’ into patients – a transformation not to be undertaken lightly. ‘If […]

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Mother’s kiss

Low-tech approaches can have dramatic effects too. Young children sometimes place small objects – plastic toys or beads, for example […]

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Breast cancer

The treatment of breast cancer provides another example of professional uncertainty. There is considerable variability in the use of surgery, […]

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Mutilating surgery

Until the middle of the 20th century, surgery was the main treatment for breast cancer. This was based on the […]

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Pester power and new drugs

‘New drugs by their very nature are incomplete products, as full information about their safety, effectiveness and impact on costs […]

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A key partnership

‘People-focused research in the NHS simply cannot be delivered without the involvement of patients and the public. No matter how […]

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Dodgy, devious and duped?

Writing a light-hearted article for a Christmas edition of the British Medical Journal, two researchers created a spoof company called […]

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Stroke

Another example of unnecessary research, yet again because the results of preceding studies had not been gathered together and analyzed, […]

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Psychiatric disorders

Regrettably, research is not always well done or relevant. Take the example of a distressing condition known as tardive dyskinesia. […]

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HIV infection in children

The results of good research are also making a real difference to children infected with HIV (human immunodeficiency virus), the […]

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Pre-eclampsia in pregnant women

Another outstanding example of good research concerns pregnant women. Worldwide, about 600,000 women die each year of pregnancy-related complications. Most […]

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Stroke

Stroke is a leading cause of death and long-term disability. The death rate is between one in six and two […]

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Biased ethics

‘If a clinician tries a new therapy with the idea of studying it carefully, evaluating outcomes, and publishing the results, […]

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In an ideal world

‘In an ideal world, wherever possible, we could be gathering anonymised outcome data and comparing this against medication history, making […]

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Information and consent

Requirements relating to provision of information and consent for studies are one of the ways in which the regulatory system […]

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Marketing-based medicine

‘Internal documents from the pharmaceutical industry suggest that the publicly available evidence base may not accurately represent the underlying data […]

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Why did you start?

‘Few principles are more fundamental to the scientific and ethical validity of clinical research than that studies should address questions […]

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Is one study ever enough?

The simple answer is ‘hardly ever’. Very seldom will one fair treatment comparison yield sufficiently reliable evidence on which to […]

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The Yellow Card Scheme

The Yellow Card Scheme was launched in Britain in 1964 after the thalidomide tragedy highlighted the importance of following up […]

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Believing is seeing

The British doctor Richard Asher noted in one of his essays for doctors: ‘If you can believe fervently in your […]

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Comparing like with like

In this sub-section Comparisons are key (this page) Treatments with dramatic effects Treatments with moderate but important effects Comparisons are […]

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When practitioners disagree

In this sub-section Introduction (this page) Caffeine for breathing problems in premature babies Antibiotics in pre-term labour Breast cancer Introduction […]

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The Screening Circus

In 2009, a recently retired professor of neurology with a long-standing interest in stroke prevention learnt that neighbours had received […]

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Selling screening

‘Selling screening can be easy. Induce fear by exaggerating risk. Offer hope by exaggerating the benefit of screening. And don’t […]

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Is anyone normal?

Whole-body CT scans Among the tests on offer at private clinics are whole-body computed tomography (CT) scans to look at […]

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Diethylstilboestrol

At one time, doctors were uncertain whether pregnant women who had previously had miscarriages and stillbirths could be helped by […]

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Herceptin

Commercial companies are not alone in trumpeting the advantages of new treatments while down-playing drawbacks. Professional hype and enthusiastic media […]

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Mechanical heart valves

Drugs are not the only treatments that can have unexpected bad effects: non-drug treatments can pose serious risks too. Mechanical […]

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Avandia

2010 saw another drug – rosiglitazone, better known by the trade name Avandia – hitting the headlines because of unwanted […]

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Vioxx

Although drug-testing regulations have been tightened up considerably, even with the very best drug-testing practices there can be no absolute […]

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Thalidomide

Thalidomide is an especially chilling example of a new medical treatment that did more harm than good. [1] This sleeping […]

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