Thread by @drjohnm, Giving talks in which you don't have a slide deck already made [...]

John Mandrola, MD

drjohnm

Giving talks in which you don't have a slide deck already made is illuminating. Look what I found out about publication bias>
It was "discovered" in 1979 by Rosenthal https://content.apa.org/record/1979-27602-001
How did he do this?
Thread ...

He used a variant of ...sit down for this...the Fragility Index, which we reported on in cardiology
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.119.005755
The criticism was fierce. But I liked it. @ShahzebKhanMD

Fragility Index in Cardiovascular Randomized Controlled Trials

Background: Efficacy of an intervention is commonly evaluated using P values, in addition to effect size measures such as absolute risk reduction, relative risk reduction, and numbers needed to treat

https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.119.005755

Here's Rosenthal's explanation

I am no stats person but this looks a lot like a fragility concept applied to all studies.

Rosenthal's conclusion -- prescient.

Here is Steve Nissen in 2013 in @JAMAInternalMed https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1672288?appId=scweb

Clinical trial registration has probably got us to a better place now. But still, I think this supports a #medicalconservative approach to evidence translation.
Happy to hear thoughts on this from anyone. cc @kaulcsmc @gcfmd @AndrewFoy82 @califf001
@LuisCLCorreia

I know @eturnermd1 has a wonderful paper in NEJM on this issue with anti-depressant drugs
(I wonder if most patients know about this? These drugs are super common) https://www.nejm.org/doi/full/10.1056/nejmsa065779

You can follow @drjohnm.

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