“…. half of current published peer-reviewed clinical research papers … contain at least one statistical error… When just surgical related papers were analysed, 78% were found to contain statistical errors.”
Peer reviewed published research is the go to source for clinicians and researchers to advance their knowledge on the topic at hand. It also currently the most reliable way available to do this. The rate of change in standard care and exponential development and implementation of innovative treatments and styles of patient involvement makes keeping up with the latest research paramount. (1)
Unfortunately, almost half of current published peer-reviewed clinical research papers have been shown to contain at least one statistical error, likely resulting in incorrect research conclusions being drawn from the results. When just surgical related papers were analysed, 78% were found to contain statistical errors due to incorrect application of statistical methods. (1)
Compared to 20 years ago all forms of medical research require the application of increasingly complex methodology, acquire increasingly varied forms of data, and require increasingly sophisticated approaches to statistical analysis. Subsequently the meta-analyses required to synthesise these clinical studies are increasingly advanced. Analytical techniques that would have previously sufficed and are still widely taught are now no longer sufficient to address these changes. (1)
The number of peer reviewed clinical research publications has increased over the past 12 years. Parallel to this, the statistical analyses contained in these papers are increasingly complex, as is the sophistication with which they are applied. For example, t tests and descriptive statistics were the go to statistical methodology for many highly regarded articles published in the 1970’s and 80’s. To rely on those techniques today would be insufficient, both in terms of being scientifically satisfying and in, in all likelihood, in meeting the current peer-review standards. (1)
Despite this, some concerning research has noted that these basic parametric techniques are actually currently still being misunderstood and misapplied reasonably frequently in contemporary research. They are also being increasingly relied upon (in line with the increase in research output) when in fact more sophisticated and modern analytic techniques would be better equipped and more robust in answering given research questions. (1)
Another contributing factor to statistical errors is of course ethical in nature. An recent online survey consulting biostatisticians in America revealed that inappropriate requests to change or delete data to support a hypothesis were common, as was the desire to mould the interpretation of statistical results of to fit in with expectations and established hypotheses, rather than interpreting results impartially. Ignoring violations of statistical assumptions that would deem to chosen statistical test inappropriate, and not reporting missing data that would bias results were other non-ethical requests that were reported. (2)
The use of incorrect statistical methodology and tests leads to incorrect conclusions being widely published in peer reviewed journals. Due to the reliance of clinical practitioners and researchers on these conclusions, to inform clinical practice and research directions respectively, the end result is a stunting of knowledge and a proliferation of unhelpful practices which can harm patients. (1)
Often these errors are a result of clinicians performing statistical analyses themselves without first consulting a biostatistician to design the study, assess the data and perform any analyses in an appropriately nuanced manner. Another problem can arise when researchers rely on the statistical techniques of a previously published peer-reviewed paper on the same topic. It is often not immediately apparent whether a statistician has been consulted on this established paper. Thus it is not necessarily certain whether the established paper has taken the best approach to begin with. This typically does not stop it becoming a benchmark for future comparable studies or deliberate replications. Further to this it can very often be the case that the statistical methods used have since been improved upon and other more advanced or more robust methods are now available. It can also be the case that small differences in the study design or collected data between the established study and the present study mean that the techniques used in the established study are not the most optimal techniques to address the statistical needs of present study, even if the research question is the same or very similar.
Another common scenario which can lead to the implementation of non-ideal statistical practices is under-budgeting for biostatisticians on research grant applications. Often biostatisticians are on multiple grants, each with a fairly low amount of funding allocated to the statistical component due to tight or under budgeting. This limits the statistician’s ability to focus substantially on a specific area and make a more meaningful contribution in that domain. A lack of focus prevents them from becoming a expert at this particular niche and engage in innovation.This in turn can limit the quality of the science as well as the career development of the statistician.
In order to reform and improve the state and quality of clinical and other research today, institutions and individuals must assign more value to the role of statisticians in all stages of the research process. Two ways to do this are increased budgeting for and in turn increased collaboration with statistical professionals.