OHRI 10th Annual
Clinical Research Training
22 October 2015
Thinking About Equity,
Applicability, & Efficiency
in Health Research
Views expressed in this presentation are
personal and do not necessarily reflect
the views of:
• National Center for Biotechnology Information (NCBI)
• National Library of Medicine (NLM)
• National Institutes of Health (NIH)
• US Department of Health and Human Services
rights & impact
In clinical care
* Bastian H. Speaking up for ourselves: the evolution of consumer advocacy in health
care. Int J Technol Assessment Health Care 1998; 14: 3-23.
Effective interventions for bias & stigma?
Cooper LA et al. Patient-centered communication, ratings
of care and concordance of patient and physician race. Ann
Intern Med 2003; 139: 907-915.
New sources of stigma emerge, too
Forms of methods
Too much faith in
when they become
14 trials a day
• Cochrane Database Systematic Reviews by the numbers (Cochrane.org)
• Moher et al (2007). Epidemiology & reporting characteristics of systematic
reviews. PLOS Medicine.
• 2014 update of Moher (2007) by Page et al, Cochrane Vienna ID RO 4.6
Data updated from 2007 to 2013
Mismatch of methods with problems increasing inequity?
Communication & knowledge translation research
Situations that are
too far from reality
& realistic evaluation
Lorenc T et al. What types of intervention generate inequalities?
Evidence from systematic reviews. J Epidemiol Community Health
2013; 67: 190-193.
Bastian H. Just how demanding can we get before we blow it? BMJ
2003; 326: 1277-1278.
Unrepresentative study populations,
highly artificial contexts
My own data extraction for a single meta-analysis in: Stacey D et al. Decision aids for people
facing health treatment or screening decisions. Cochrane Database Syst Rev 2011, Issue 10.
Stacey D et al. Decision aids for people facing health treatment or
screening decisions. Cochrane Database Syst Rev 2011, Issue 10.
Example: the NNT
Widely advocated without
good evidence for its claims
Hard to understand (11 trials,
Bias towards under-
* Bastian H. Mind your “p”s, RRs & NNTs… Absolutely Maybe March 2015:
Bastian H. The NNT: An overhyped & confusing statistic. Third Opinion (MedPage Today)
March 2015: http://www.medpagetoday.com/Blogs/ThirdOpinion/50273
bias in research
• More support needed for
• Better retrievability &
linkages of trials &
• Language barrier in
Optimize peer-to-peer use of
“Don’t tell me what to do –
Show me how to do it.”
Ways of using machines >>
less time tedious effort,
more time thinking
Glasziou P et al. Taking healthcare
interventions from trial to practice.
BMJ 2010, 341.
researchers & agencies
• True open access is
also for data mining &
• Reporting requirements
could be more specific
- trial registration number at the end of the
- Authors always list the number in citation &
when first mentioned
Bastian H. Why aren’t we all machine-friendly researchers? Absolutely Maybe October 2015.