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. 2022 Jul;47(7):395-400.
doi: 10.1136/rapm-2021-103331. Epub 2022 Apr 1.

Why science is less scientific than we think (and what to do about it): The 2022 Gaston Labat Award Lecture

Brian M Ilfeld  1   2
Affiliations

Why science is less scientific than we think (and what to do about it): The 2022 Gaston Labat Award Lecture

Brian M Ilfeld. Reg Anesth Pain Med. 2022 Jul.
No abstract available

Keywords: health care; methods; outcome assessment; pain measurement; pain perception; treatment outcome.

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Conflict of interest statement

Competing interests: The University of California has received funding and product for Dr. Ilfeld’s research from Epimed International (Farmers Branch, TX); Avanos (Irvine, CA); Infutronics (Natick, MA); and SPR Therapeutics (Cleveland, OH).

Figures

Figure 1
Figure 1
An example of a torpedo fish which can produce electrical current of up to 220 volts.
Figure 2
Figure 2
An example of an ‘anchor-based’ method to determine the smallest improvement in analgesia that individual patients consider relevant or important.
Figure 3
Figure 3
An example of the problem extrapolating the smallest change that is important to individual patients to the evaluation of group differences. This example is simplified to convey the general concept—reality is (unfortunately) more complex.
Figure 4
Figure 4
]Visual representation of joint hypothesis testing and a parallel gatekeeping procedure. Gatekeeping permits statistical comparisons of many variables while retaining a study-wide type I error at a 0.05, increasing confidence in all comparisons and aiding interpretation and generalization of the results. In this example, the study outcomes are prospectively prioritized into three ordered sets. On study conclusion, statistical testing proceeds through each ‘gate’ to the next set if and only if at least one outcome in the current set reached significance. The significance level for each set will be 0.05 times a cumulative penalty for non-significant results in previous sets (ie, a ‘rejection gain factor’ equal to the cumulative product of the proportion of significant tests across the preceding sets). Within a set, a multiple comparison procedure (Bonferroni correction) is used to control the type I error at the appropriate level, if needed. Adapted from a grant proposal coauthored with Edward Mascha, PhD (Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA).
Figure 5
Figure 5
Examples of various presentation formats of the same dataset. Study participants included adult patients with postamputation phantom limb pain who all received a single-injection peripheral nerve block with ropivacaine and a perineural catheter(s). Participants were randomized to receive 6 days of either perineural ropivacaine or normal saline, and the primary outcome measure was the improvement in the average pain score queried 4 weeks following infusion initiation as measured using a 0–10 Numeric Rating Scale. Note that the combination of information improves interpretation of the results, and different formats may be valuable to differing stakeholders such as clinicians, patients, administrators, and other researchers. Adapted from Ilfeld et al. Some results are preliminary and should be used for demonstration purposes only (final analysis currently in preparation).
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References

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