Carl Heneghan

How's that for a list?

Anyhow, just for EBM nerds out there, there is something that might be of interest to people.

There was a paper some way back in the BMJ about the Zelen design.

Ah, yeah, you see, you're now on your way to... I think you're showing off, Carl.

Um...

It's basically to account for this idea of patient preference in the designer trials.

And what Zelen Design does is randomise people before consent to actually see what they will actually do when they get assigned to the treatment or not.

and it tries to account for what would be the impact on patient preference.

And some people have said, well, it's unethical to do that.

But often a problem is you go into a trial, you get consented, and then people, randomised particularly in surgery, say you're not going to get the surgery, and then they withdraw.

And you have a super, you have a big problem then in balancing the arms.

So what Zelen does, and there's a paper back in the BMJ in 98, is randomise you before consent to see what will actually happen.

Interesting issue.

Yeah, so look, I think this is a really interesting issue.

So there are a couple of things that come to mind.

There's a paper by Johnny in Ardis that said you can overcome small effects with any introduction of bias.

So one of the most important aspects about any trial outcome is the size of effect matters.

So if the effect is tiny...

You really worry about any introduction of bias.

The second issue that what comes with bias is we're sort of railing now against this sort of formulaic approach, which we've introduced over the last 15, 20 years, where the quality of studies comes down to three or four measures.