Week 3 update - feeling like garbage tbh

Dr.PainCLE said:

The gap between trial results and real-world results is consistent and it is not fraud.

I read this differently from Dr.PainCLE, on substance rather than tone. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.

I would rather be corrected than agreed with, if it comes to it.

JessicaH_TX 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…

JessicaH_TX said:

...regarding the trial evidence...

I think this is an underappreciated point. To expand on it with some data:

A recent meta-analysis of 15 RCTs (n=12,300) found that the trial evidence was associated with a clinically meaningful effect size across diverse patient populations[1].

The NNT was 12, which is comparable to statins for secondary prevention. That's a strong clinical argument for this approach.

HPLC_Greg said:

I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.

Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:

1. Point estimate (HR/RR/OR) — center of the diamond
2. Confidence interval width — precision of the estimate
3. I² statistic — heterogeneity across studies
4. Individual study weights — are results driven by one large trial?
5. Prediction interval — range of plausible true effects in future settings

The the trial evidence meta-analysis shows a pooled RR of 0.78 (95% CI 0.69-0.88), I²=36%. This is a robust and consistent effect.

Following on from paul_denver — and this may be the naive question:

How would you tell the difference between that and the alternative explanation?

Closing the loop on my own question.

Update — my curve sits below the published mean and the explanation is that the trial arm had support I do not have. That was reassuring rather than otherwise.