Much ado about something: a response to "COVID-19: underpowered randomised trials, or no randomised trials?"
Trials
; 22(1): 780, 2021 Nov 07.
Article
in English
| MEDLINE | ID: covidwho-1582024
ABSTRACT
Non-pharmaceutical interventions (NPI) for infectious diseases such as COVID-19 are particularly challenging given the complexities of what is both practical and ethical to randomize. We are often faced with the difficult decision between having weak trials or not having a trial at all. In a recent article, Dr. Atle Fretheim argues that statistically underpowered studies are still valuable, particularly in conjunction with other similar studies in meta-analysis in the context of the DANMASK-19 trial, asking "Surely, some trial evidence must be better than no trial evidence?" However, informative trials are not always feasible, and feasible trials are not always informative. In some cases, even a well-conducted but weakly designed and/or underpowered trial such as DANMASK-19 may be uninformative or worse, both individually and in a body of literature. Meta-analysis, for example, can only resolve issues of statistical power if there is a reasonable expectation of compatible well-designed trials. Uninformative designs may also invite misinformation. Here, we make the case that-when considering informativeness, ethics, and opportunity costs in addition to statistical power-"nothing" is often the better choice.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Randomized Controlled Trials as Topic
/
COVID-19
Type of study:
Experimental Studies
/
Prognostic study
/
Randomized controlled trials
/
Reviews
Limits:
Humans
Language:
English
Journal:
Trials
Journal subject:
Medicine
/
Therapeutics
Year:
2021
Document Type:
Article
Affiliation country:
S13063-021-05755-Y
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