This one has a reasonably settled answer, so here it is. 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.
I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same direction.
What would genuinely help is knowing how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.
I would rather have one careful answer than five confident ones.
TirzTom said:Relative and absolute effects need reading together.
TirzTom 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 ResultsDr.ObesityMed said:I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same…
Can confirm the pattern Dr.ObesityMed describes. 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.
If somebody has the primary source to hand I would rather cite it than paraphrase it.
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:
- Point estimate (HR/RR/OR) — center of the diamond
- Confidence interval width — precision of the estimate
- I² statistic — heterogeneity across studies
- Individual study weights — are results driven by one large trial?
- Prediction interval — range of plausible true effects in future settings
The the trial evidence meta-analysis shows a pooled RR of 0.85 (95% CI 0.70-0.85), I²=43%. This is a robust and consistent effect.