My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my material.
A quick sanity check on any figure quoted here: is it mean or median, is it intention-to-treat or completers, and what was the comparator. Three questions, and they resolve most disagreements in these threads.
What I am trying to establish is how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.
If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
Taking the question as asked, rather than the general version of it. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.
LibrarianMeg said:Relative and absolute effects need reading together.
LibrarianMeg said:...regarding the trial evidence...
I think this is an underappreciated point. To expand on it with some data:
A recent meta-analysis of 22 RCTs (n=18,900) found that the trial evidence was associated with a consistent effect size across diverse patient populations[1].
The NNT was 20, which is comparable to metformin for T2DM prevention. That's a strong clinical argument for this approach.
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View ResultsSteveThurs said:My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my…
Same position here, arrived at the long way round. The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.
From the other side of the consultation, briefly.
Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:
The the trial evidence meta-analysis shows a pooled RR of 0.74 (95% CI 0.65-0.84), I²=32%. This is a robust and consistent effect.