principles for the ethical analysis of clinical and translational research jonathan gelfond, md...
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Principles for the Ethical Principles for the Ethical Analysis ofAnalysis ofClinical And Translational Clinical And Translational ResearchResearch
Jonathan Gelfond, MD PhD Elizabeth Heitman, PhDCraig Klugman, PhD Vanderbilt UniversityBrad Pollock, MPH PhDUT Health Science CenterSan Antonio, Texas
ObjectivesObjectives1 Research ethics includes more than
just human subject issues.2 Statistical standards in clinical
translational research are an ethical responsibility.
3 Good statistical practice goes beyond avoiding intentional misrepresentation.
4 Define the basic elements and principles of good statistical practice.
Statistical Analysis CriticalStatistical Analysis Criticalin Translational Researchin Translational Research
1 Incorrect stats could harm participants2 Invalid stats may squander resources3 Poor stats diminish the scientific value
of resultant discoveries4 Poor stats promote public distrust in
research5 Poor analysis could harm the public at
large6 Poor stats harm the reputation of the
statistical profession
Parsimonious Model Selection
AppropriateStudy Design
Quantification of Evidence
Avoidance ofMisinterpretation
Verification ofAssumptions
Research Timeline
Objectivity
Multidisciplinary Expertise (Statistical & Scientific)
Openness & Transparency
Accuracy of Data & Computation
Gelfond J, Heitman E, Pollock B, Klugman C: Principles for the Ethical Analysis of Clinical and Translational Research. Statistics in Medicine 2011, 30(23):2785-2792.
Ethical Guidelines
Element 1 Element 1
Acceptance of Professional Ethical Guidelines
Element 2Element 2Multidisciplinary Expertise:Scientific & Statistical
Expertise or not?Expertise or not?Range of Knowledge and Skill
◦Competence◦Expertise◦Authority◦Identity
Should non-statisticians perform analyses?◦Degree of difficulty & risk
Element 3Element 3
Objectivity:The analyses should not be conducted to unduly favor one set of hypotheses.
Element 4Element 4Openness and Transparency:All relevant data and analyses must be presented.
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Openness & TransparencyOpenness & TransparencyAccountability through
DocumentationDocumentation is currently poor
◦Document the good the bad & the uglyTechnically challenging
◦Need a dataset “electronic health record”◦Data Provenance systems
Ethically challenging◦Privacy for study participants◦Confidentiality for researchers
Element 5Element 5Verification ofAssumptions(Conditions for Validity)
Element 6Element 6Accuracy of the primary data and computation
AccuracyAccuracyNo Fabrication of DataErrors by neglect are unethicalSubstandard practices promote
errors◦Use of Excel◦Use of point-and-click software◦Published stats & p-values are often
wrongReproducibility in Statistics
Element 7Element 7
Appropriate Experimental Design and Sample Size
Appropriate Design &Appropriate Design &Sample SizeSample SizePoorly designed experiments have
little positive value and are seldom recoverable by statistical analyses
Too few patients are noninformative
Too many patients may cause excessive harm
Element 8Element 8Parsimonious Model SelectionWeighed AgainstPrecision, Bias, and Validity
Trade-offs in Model Trade-offs in Model SelectionSelection
Parsimony
VarianceBias
Fit with Data
Element 9Element 9Interpretable quantification of evidence
Element 10Element 10
Avoidance of misinterpretation
Avoidance of Avoidance of MisinterpretationMisinterpretationClaims not supported by
evidence are harmful
Interpretation of statistical results occurs after analyses by◦Authors◦Editors◦Journalists◦Practitioners
Avoidance of Avoidance of MisinterpretationMisinterpretationBoutron et al JAMA(2010)
◦Study of Negative Randomized Trials
◦Use of spin in 40% these trials!