personalized medicine

S. Senn: Personal perils: are numbers needed to treat misleading us as to the scope for personalised medicine? (Guest Post)

Personal perils: are numbers needed to treat misleading us as to the scope for personalised medicine?

A common misinterpretation of Numbers Needed to Treat is causing confusion about the scope for personalised medicine.

Stephen Senn
Consultant Statistician,
Edinburgh

Introduction

Thirty years ago, Laupacis et al1 proposed an intuitively appealing way that physicians could decide how to prioritise health care interventions: they could consider how many patients would need to be switched from an inferior treatment to a superior one in order for one to have an improved outcome. They called this the number needed to be treated. It is now more usually referred to as the number needed to treat (NNT).

Within fifteen years, NNTs were so well established that the then editor of the British Medical Journal, Richard Smith could write:  ‘Anybody familiar with the notion of “number needed to treat” (NNT) knows that it’s usually necessary to treat many patients in order for one to benefit’2. Fifteen years further on, bringing us up to date,  Wikipedia makes a similar point ‘The NNT is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial).’3

This common interpretation is false, as I have pointed out previously in two blogs on this site: Responder Despondency and  Painful Dichotomies. Nevertheless, it seems to me the point is worth making again and the thirty-year anniversary of NNTs provides a good excuse. Continue reading

Categories: personalized medicine, PhilStat/Med, S. Senn | 7 Comments

S. Senn: Evidence Based or Person-centred? A Statistical debate (Guest Post)

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Stephen Senn
Head of  Competence Center
for Methodology and Statistics (CCMS)
Luxembourg Institute of Health
Twitter @stephensenn

Evidence Based or Person-centred? A statistical debate

It was hearing Stephen Mumford and Rani Lill Anjum (RLA) in January 2017 speaking at the Epistemology of Causal Inference in Pharmacology conference in Munich organised by Jürgen Landes, Barbara Osmani and Roland Poellinger, that inspired me to buy their book, Causation A Very Short Introduction[1]. Although I do not agree with all that is said in it and also could not pretend to understand all it says, I can recommend it highly as an interesting introduction to issues in causality, some of which will be familiar to statisticians but some not at all.

Since I have a long-standing interest in researching into ways of delivering personalised medicine, I was interested to see a reference on Twitter to a piece by RLA, Evidence based or person centered? An ontological debate, in which she claims that the choice between evidence based or person-centred medicine is ultimately ontological[2]. I don’t dispute that thinking about health care delivery in ontological terms might be interesting. However, I do dispute that there is any meaningful choice between evidence based medicine (EBM) and person centred healthcare (PCH). To suggest so is to commit a category mistake by suggesting that means are alternatives to ends.

In fact, EBM will be essential to delivering effective PCH, as I shall now explain. Continue reading

Categories: personalized medicine, RCTs, S. Senn | 7 Comments

Your (very own) personalized genomic prediction varies depending on who else was around?

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personalized medicine roulette

As if I wasn’t skeptical enough about personalized predictions based on genomic signatures, Jeff Leek recently had a surprising post about a “A surprisingly tricky issue when using genomic signatures for personalized medicine“.  Leek (on his blog Simply Statistics) writes:

My student Prasad Patil has a really nice paper that just came out in Bioinformatics (preprint in case paywalled). The paper is about a surprisingly tricky normalization issue with genomic signatures. Genomic signatures are basically statistical/machine learning functions applied to the measurements for a set of genes to predict how long patients will survive, or how they will respond to therapy. The issue is that usually when building and applying these signatures, people normalize across samples in the training and testing set.

….it turns out that this one simple normalization problem can dramatically change the results of the predictions. In particular, we show that the predictions for the same patient, with the exact same data, can change dramatically if you just change the subpopulations of patients within the testing set.

Here’s an extract from the paper,”Test set bias affects reproducibility of gene signatures“:

Test set bias is a failure of reproducibility of a genomic signature. In other words, the same patient, with the same data and classification algorithm, may be assigned to different clinical groups. A similar failing resulted in the cancellation of clinical trials that used an irreproducible genomic signature to make chemotherapy decisions (Letter (2011)).

This is a reference to the Anil Potti case:

Letter, T. C. (2011). Duke Accepts Potti Resignation; Retraction Process Initiated with Nature Medicine.

But far from the Potti case being some particularly problematic example (see here and here), at least with respect to test set bias, this article makes it appear that test set bias is a threat to be expected much more generally. Going back to the abstract of the paper: Continue reading

Categories: Anil Potti, personalized medicine, Statistics | 10 Comments

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