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To Infinity and Beyond
How ‘big’ are your data, really ?
Stephen Senn
Consultant Statistician
Edinburgh
(c) Stephen Senn 1
stephen@senns.uk
Acknowledgements
Many thanks for the invitation
This work is partly supported by the European Union’s 7th Framework
Programme for research, technological development and
demonstration under grant agreement no. 602552. “IDEAL”
(c) Stephen Senn 2(c) Stephen Senn 2
Outline
Part I (Not so technical and shorter)
• The roots of modern statistics
• Small data
• Careful design of experiments
• Some examples of problems with
judging causality from associations
in the health care field
• Two different objectives of clinical
trials
Part II (More technical and longer)
• Design
• The Rothamsted (Genstat)
approach
• Some statistical issues
• Conclusion
(c) Stephen Senn 3
Basic Thesis
• We know that there is a close and fundamental relationship between
how experiments are designed and how they should be analysed
• This should make us worry whenever we have to analyse data that
are not from a carefully designed study, however big that study may
be
• We should be sceptical of many of the claims we hear for the power
of ‘big data’
(c) Stephen Senn 4
Part I
Less technical matter to do with history of statistics and basic ‘philosophical’
considerations
(c) Stephen Senn 5
(c) Stephen Senn 6
John Nelder & Michael Healy
(c) Stephen Senn 7
William Sealy Gosset
1876-1937
• Born Canterbury 1876
• Educated Winchester and Oxford
• First in mathematical moderations 1897
and first in degree in Chemistry 1899
• Starts with Guinness in 1899 in Dublin
• Autumn 1906-spring 1907 with Karl
Pearson at UCL
• 1908 publishes ‘The probable error of a
mean’
• First method available to judge
‘significance’ in small samples
(c) Stephen Senn 8
Ronald Aylmer Fisher
1890-1962
• Most influential statistician ever
• Also major figure in evolutionary
biology
• Educated Harrow and Cambridge
• Statistician at Rothamsted agricultural
station 1919-1933
• Developed theory of small sample
inference and many modern concepts
• Likelihood, variance, sufficiency, ANOVA
• Developed theory of experimental
design
• Blocking, Randomisation, Replication,
Small data challenges
Situation Problem Solution
Sample size small Too few data to estimate variance
adequately
Develop small sample test
(Student)
Experimental material not
homogenous
Dealing with variability Blocking and randomisation
(Fisher)
Limited time (1) How to study more than one thing Complex treatment structure
factorial experiments (Fisher, Yates)
Limited time (2) How to study very many factors Fractional factorials. (Yates)
Experimental material varies at
different levels
Some treatments can be varied at
lowest level but not all
General balance approach to
analysis (Nelder)
(c) Stephen Senn 9
Characteristics of development of statistics in
the first half of the 20th century
• Numerical work was arduous and long
• Human computers
• Desk calculators
• Careful thought as to how to perform a calculation paid dividends
• Much development of inferential theory for small samples
• Design of experiments became a new subject in its own right developed by
statisticians
• Orthogonality
• Made calculation easier (eg decomposition of variance terms in ANOVA)
• Increased efficiency
• Randomisation
• “Guaranteed” properties of statistical analysis
• Dealt with hidden confounders
• Factorial experimentation
• Efficient way to study multiple influences
(c) Stephen Senn 10
TARGET study
• Trial of more than 18,000
patients in osteoarthritis over
one year or more
• Two sub-studies
• Lumiracoxib v ibuprofen
• Lumiracoxib v naproxen
• Stratified by aspirin use or not
• Has some features of a
randomised trial but also
some of a non-randomised
study
(c) Stephen Senn 11
Data Filtering Some Examples
Finding
• Oscar winners lived longer than actors who
didn’t win an Oscar
• A 20 year follow-up study of women in an
English village found higher survival amongst
smokers than non-smokers
• Transplant receivers on highest doses of
cyclosporine had higher probability of graft
rejection than on lower doses
• Left-handers observed to die younger on
average than right-handers
• Obese infarct survivors have better prognosis
than non-obese
Possible Explanation
• The longer you live the greater your
chance of winning
• The smokers were from more recent
generations. They were much younger
than non-smokers
• The anticipated transplant rejection was
the cause of the dose being increased
• In an earlier era left-handers were forced
to become right-handers
• There are two kinds of infarct: very
serious which is independent of weight
and less serious linked to obesity.
(c) Stephen Senn 12
Morals
• What you don’t see can be important
• Where you have not been able to run trials, biases
can be very important
• TARGET study provides a strong warning
• Observational studies show that alternative explanations
are possible
• For some purposes just piling on data does not really
help
• What helps are
• Careful design
• Thinking!
(c) Stephen Senn 13
We tend to believe “the truth is in
there”, but sometimes it isn’t and
the danger is we will find it
anyway
(c) Stephen Senn 14
Causal versus predictive inference
• Clinical trials can be used to try and answer a number of very
different questions
• Two examples are
• Did the treatment have an effect in these patients?
• A causal purpose
• What will the effect be in future patients?
• A predictive purpose
• Unfortunately, in practice, an answer is produced without stating
what the question was
• Given certain assumptions these questions can be answered using the
same analysis but the assumptions are strong and rarely stated
(c) Stephen Senn 15
Two models
Predictive
• The population is taken to be ‘patients in
general’
• Of course this really means future
patients
• They are the ones to whom the
treatment will be applied
• We treat the patients in the trial as an
appropriate selection from this population
• This does not require them to be typical
but it does require additivity of the
treatment effect
Causal
• We take the patients as fixed
• We want to know what the effect was for
them
• Unfortunately there are missing
counterfactuals
• What would have happened to control
patients given intervention and vice-versa
• The population is the population of all
possible allocations to the patients studied
(c) Stephen Senn 16
Coverage probabilities for two questions
Predictive Causal
(c) Stephen Senn 17
60 trials
Part II
Technical matters to do with design and inference
(c) Stephen Senn 18
Trial in asthma
Basic situation
• Two beta-agonists compared
• Zephyr(Z) and Mistral(M)
• Block structure has several levels
• Different designs will be investigated
• Cluster
• Parallel group
• Cross-over Trial
• Each design will be blocked at a different
level
• NB Each design will collect
6 x 4 x 2 x 7 = 336 measurements of Forced
Expiratory Volume in one second (FEV1)
Block structure
Level Number
within higher
level
Total
Number
Centre 6 6
Patient 4 24
Episodes 2 48
Measurements 7 336
(c) Stephen Senn 19
Block structure
• Patients are nested with centres
• Episodes are nested within patients
• Measurements are nested within
episodes
• Centres/Patients/Episodes/Measurements
(c) Stephen Senn 20
Measurements not shown
Possible designs
• Cluster randomised
• In each centre all the patients either receive Zephyr (Z) or Mistral (M) in both
episodes
• Three centres are chosen at random to receive Z and three to receive M
• Parallel group trial
• In each centre half the patients receive Z and half M in both episodes
• Two patients per centre are randomly chosen to receive Z and two to receive
M
• Cross-over trial
• For each patient the patient receives M in one episode and Z in another
• The order of allocation, ZM or MZ is random
(c) Stephen Senn 21
(c) Stephen Senn 22
(c) Stephen Senn 23
(c) Stephen Senn 24
Null (skeleton) analysis of variance with Genstat ®
Code Output
(c) Stephen Senn 25
BLOCKSTRUCTURE Centre/Patient/Episode/Measurement
ANOVA
Full (skeleton) analysis of variance with Genstat ®
Additional Code Output
(c) Stephen Senn 26
TREATMENTSTRUCTURE Design[]
ANOVA
(Here Design[] is a pointer with values corresponding
to each of the three designs.)
The bottom line
• The approach recognises that things vary
• Centres, patients episodes
• It does not require everything to be balanced
• Things that can be eliminated will be eliminated by design
• Cross-over trial eliminates patients and centres
• Parallel group trial eliminates centres
• Cluster randomised eliminates none of these
• The measure of uncertainty produced by the analysis will reflected what
cannot be eliminated
• This requires matching the analysis to the design
• Note that Genstat® deals with this formally and automatically. Other
packages do not.
(c) Stephen Senn 27
(c) Stephen Senn 28
To call in the statistician after
the experiment is done may be
no more than asking him to
perform a post-mortem
examination: he may be able
to say what the experiment
died of
RA Fisher
A genuine example ( a real trial)
Hills and Armitage 1979
• A cross-over trial of enuresis
• Patients randomised to one of two sequences
• Active treatment in period 1 followed by placebo in period 2
• Placebo in period 1 followed by active treatment in period 2
• Treatment periods were 14 days long
• Number of dry nights measured
(c) Stephen Senn 29
Important points to note
• Because every patient acts as his own control all patient level
covariates (of which there could be thousands and thousands) are
perfectly balanced
• Differences in these covariates can have no effect on the difference
between results under treatment and the results under placebo
• However, period level covariates (changes within the lives of patients)
could have an effect
• My normal practice is to fit a period effect as well as patients effects,
however, I shall omit doing so to simplify
• The parametric analysis then reduces to what is sometimes called a
matched pairs t-test
(c) Stephen Senn 30
Cross-over trial in
Enuresis
Two treatment periods of
14 days each
1. Hills, M, Armitage, P. The two-period
cross-over clinical trial, British Journal of Clinical
Pharmacology 1979; 8: 7-20.
(c) Stephen Senn 31
Two Parametric Approaches
Not fitting patient effect
Estimate s.e. t(56) t pr.
2.172 0.964 2.25 0.0282
Fitting patient effect
Estimate s.e. t(28) t pr
.
2.172 0.616 3.53 0.00147
(c) Stephen Senn
Note that ignoring the patient effect, the P-value is less impressive and the standard
error is larger
The method posts higher uncertainty because unlike the within-patient analysis it make
no assumption that the patient level covariates are balanced.
Of course, in this case, since we know the patient level covariates are balanced, this
analysis is wrong
32
Blue diamond shows
treatment effect whether
we condition on patient or
not as a factor.
It is identical because the
trial is balanced by patient.
However the permutation
distribution is quite different
and our inferences are
different whether we
condition (red) or not
(black) and clearly
balancing the randomisation
by patient and not
conditioning the analysis by
patient is wrong
(c) Stephen Senn 33
The two permutation* distributions summarised
Summary statistics for Permuted difference no
blocking
Number of observations = 10000
• Mean = -0.00319
• Median = -0.0345
• Minimum = -3.621
• Maximum = 3.690
• Lower quartile = -0.655
• Upper quartile = 0.655
Standard deviation = 0.993
P-value for observed difference 0.0344
(Parametric P-value 0.0282)
*Strictly speaking, these are randomisation
distributions
Summary statistics for Permuted difference
blocking
Number of observations = 10000
• Mean = -0.00339
• Median = 0.0345
• Minimum = -2.793
• Maximum = 2.517
• Lower quartile = -0.517
• Upper quartile = 0.517
P-value for observed difference 0.001
(Parametric P-value 0.00147)
(c) Stephen Senn 34
What happens if you balance but don’t
condition?
Approach Variance of estimated
treatment effect over all
randomisations*
Mean of estimated
variance of treatment
effect over all
randomisations*
Completely randomised
Analysed as such
0.987 0.996
Randomised within-patient
Analysed as such
0.534 0.529
Randomised within-patient
Analysed as completely
randomised
0.534 1.005
*Based on 10000 random permutations
(c) Stephen Senn 35
That is to say, permute values respecting the fact that they come from a cross-over but analyse them as if
they came from a parallel group trial
36
The difference between
mathematical and applied
statistics is that the former is full
of lemmas whereas the latter is
full of dilemmas
(c) Stephen Senn
The Shocking Truth
• The validity of conventional analysis of randomised trials does not
depend on covariate balance
• It is valid because they are not perfectly balanced
• An allowance is already made for things being unbalanced
• If they were balanced the standard analysis would be wrong
• Like an insurance broker forbidding you to travel abroad in the policy but
calculating your premiums on the assumption that you will
• This accounts for unobserved covariates. What happens when they
are observed?
(c) Stephen Senn 2019 37
(c) Stephen Senn 2019
• Two dice are rolled
– Red die
– Black die
• You have to call correctly the probability of a total score of 10
• Three variants
– Game 1 You call the probability and the dice are rolled
together
– Game 2 the red die is rolled first, you are shown the score
and then must call the probability
– Game 3 the red die is rolled first, you are not shown the
score and then must call the probability
Game of Chance
38
(c) Stephen Senn 2019
Total Score when Rolling Two Dice
Variant 1. Three of 36 equally likely results give a 10. The probability is 3/36=1/12.
39
(c) Stephen Senn 2019
Variant 2: If the red die score is 1,2 or 3, the probability of a total of10 is 0.
If the red die score is 4,5 or 6, the probability of a total of10 is 1/6.
Variant 3: The probability = (½ x 0) + (½ x 1/6) = 1/12
Total Score when Rolling Two Dice
40
The morals
Dice games
• You can’t treat game 2 like game 1
• You must condition on the information
received
• You must use the actual data from the red die
• You can treat game 3 like game 1
• You can use the distribution in probability
that the red die has
Inference in general
• You can’t use the random behavior of
a system to justify ignoring
information that arises from the
system
• That would be to treat game 2 like game 1
• You can use the random behavior of
the system to justify ignoring that
which has not been seen
• You are entitled to treat game 3 like game 1
(c) Stephen Senn 2019 41
What does the Rothamsted approach do?
• Matches the allocation procedure to the analysis. You can either
regard this as meaning
• The randomisation you carried out guides the analysis
• The analysis you intend guides the randomisation
• Or both
• Either way, the idea is to avoid inconsistency
• Regarding something as being very important at the allocation stage but not
at the analysis stage is inconsistent
• Permits you not only to take account of things seen but also to make
an appropriate allowance for things unseen
• Die analogy is that it makes sure that the game is a fair one
(c) Stephen Senn 42
A simulating example
• I am going to simulate 200 clinical trials
• Trials are of a bronchodilator against placebo.
• Simple randomisation of 50 patients to each arm
• I shall have values at outcome and values at baseline
• Forced expiratory volume in one second (FEV1) in mL
• Parameter settings
• True mean under placebo 2200 mL
• Under bronchodilator 2500 mL
• Treatment effect is 300 mL
• SD at outcome and baseline is 150 mL
• Correlation is 0.7
(c) Stephen Senn 2019 43
Point estimates and confidence intervals
Baseline values not available (like game 1)
(c) Stephen Senn 2019 44
Point estimates and 95% confidence intervals
Baseline values available (Game 2)
(c) Stephen Senn 2019 45
How analysis of covariance works
• This shows ANCOVA applied to
sample 170 of the 200 simulated
• There is an imbalance at
baseline
• I have adjusted for this by fitting
two parallel lines
• The difference between the two
estimates show how an outcome
value would change for a given
baseline value if treatments
were switched
(c) Stephen Senn 2019 46
Lessons for big data
• We tend to treat observational data-sets as if they were badly
randomised parallel group trials but cluster-randomised trials might
be a better analogy
• True standard errors may be much bigger than estimated ones
• See Cox, Kartsonaki & Keogh (2018) and Xiao-Li Meng (2018)
• Design matters
• Beware of dreams in which mathematics triumphs over biology
• You can be rich in data but poor in information
(c) Stephen Senn 2019 47
A big data analyst is an expert at reaching
misleading conclusions with huge data sets,
whereas a statistician can do the same with
small ones
(c) Stephen Senn 48
References
(c) Stephen Senn 49
D. R. Cox, C. Kartsonaki and R. H. Keogh (2018) Big data: Some statistical issues. Stat Probab Lett, 111-
115.
X.-L. Meng (2018) Statistical paradises and paradoxes in big data (I): Law of large populations, big
data paradox, and the 2016 US presidential election. The Annals of Applied Statistics, 685-726.
S. J. Senn (2013) Seven myths of randomisation in clinical trials. Statistics in Medicine, 1439-1450.
S. Senn (2013) A Brief Note Regarding Randomization. Perspectives in biology and medicine, 452-453.
S. J. Senn (2019) The well-adjusted statistician. Applied Clinical Trials, June 18.
https://www.appliedclinicaltrialsonline.com/view/well-adjusted-statistician-analysis-covariance-
explained
S. Senn (2019) John Ashworth Nelder. 8 October 1924—7 August 2010: The Royal Society Publishing.
A number of blogs on my blog site are also relevant: http://www.senns.uk/Blogs.html

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To infinity and beyond v2

  • 1. To Infinity and Beyond How ‘big’ are your data, really ? Stephen Senn Consultant Statistician Edinburgh (c) Stephen Senn 1 stephen@senns.uk
  • 2. Acknowledgements Many thanks for the invitation This work is partly supported by the European Union’s 7th Framework Programme for research, technological development and demonstration under grant agreement no. 602552. “IDEAL” (c) Stephen Senn 2(c) Stephen Senn 2
  • 3. Outline Part I (Not so technical and shorter) • The roots of modern statistics • Small data • Careful design of experiments • Some examples of problems with judging causality from associations in the health care field • Two different objectives of clinical trials Part II (More technical and longer) • Design • The Rothamsted (Genstat) approach • Some statistical issues • Conclusion (c) Stephen Senn 3
  • 4. Basic Thesis • We know that there is a close and fundamental relationship between how experiments are designed and how they should be analysed • This should make us worry whenever we have to analyse data that are not from a carefully designed study, however big that study may be • We should be sceptical of many of the claims we hear for the power of ‘big data’ (c) Stephen Senn 4
  • 5. Part I Less technical matter to do with history of statistics and basic ‘philosophical’ considerations (c) Stephen Senn 5
  • 6. (c) Stephen Senn 6 John Nelder & Michael Healy
  • 7. (c) Stephen Senn 7 William Sealy Gosset 1876-1937 • Born Canterbury 1876 • Educated Winchester and Oxford • First in mathematical moderations 1897 and first in degree in Chemistry 1899 • Starts with Guinness in 1899 in Dublin • Autumn 1906-spring 1907 with Karl Pearson at UCL • 1908 publishes ‘The probable error of a mean’ • First method available to judge ‘significance’ in small samples
  • 8. (c) Stephen Senn 8 Ronald Aylmer Fisher 1890-1962 • Most influential statistician ever • Also major figure in evolutionary biology • Educated Harrow and Cambridge • Statistician at Rothamsted agricultural station 1919-1933 • Developed theory of small sample inference and many modern concepts • Likelihood, variance, sufficiency, ANOVA • Developed theory of experimental design • Blocking, Randomisation, Replication,
  • 9. Small data challenges Situation Problem Solution Sample size small Too few data to estimate variance adequately Develop small sample test (Student) Experimental material not homogenous Dealing with variability Blocking and randomisation (Fisher) Limited time (1) How to study more than one thing Complex treatment structure factorial experiments (Fisher, Yates) Limited time (2) How to study very many factors Fractional factorials. (Yates) Experimental material varies at different levels Some treatments can be varied at lowest level but not all General balance approach to analysis (Nelder) (c) Stephen Senn 9
  • 10. Characteristics of development of statistics in the first half of the 20th century • Numerical work was arduous and long • Human computers • Desk calculators • Careful thought as to how to perform a calculation paid dividends • Much development of inferential theory for small samples • Design of experiments became a new subject in its own right developed by statisticians • Orthogonality • Made calculation easier (eg decomposition of variance terms in ANOVA) • Increased efficiency • Randomisation • “Guaranteed” properties of statistical analysis • Dealt with hidden confounders • Factorial experimentation • Efficient way to study multiple influences (c) Stephen Senn 10
  • 11. TARGET study • Trial of more than 18,000 patients in osteoarthritis over one year or more • Two sub-studies • Lumiracoxib v ibuprofen • Lumiracoxib v naproxen • Stratified by aspirin use or not • Has some features of a randomised trial but also some of a non-randomised study (c) Stephen Senn 11
  • 12. Data Filtering Some Examples Finding • Oscar winners lived longer than actors who didn’t win an Oscar • A 20 year follow-up study of women in an English village found higher survival amongst smokers than non-smokers • Transplant receivers on highest doses of cyclosporine had higher probability of graft rejection than on lower doses • Left-handers observed to die younger on average than right-handers • Obese infarct survivors have better prognosis than non-obese Possible Explanation • The longer you live the greater your chance of winning • The smokers were from more recent generations. They were much younger than non-smokers • The anticipated transplant rejection was the cause of the dose being increased • In an earlier era left-handers were forced to become right-handers • There are two kinds of infarct: very serious which is independent of weight and less serious linked to obesity. (c) Stephen Senn 12
  • 13. Morals • What you don’t see can be important • Where you have not been able to run trials, biases can be very important • TARGET study provides a strong warning • Observational studies show that alternative explanations are possible • For some purposes just piling on data does not really help • What helps are • Careful design • Thinking! (c) Stephen Senn 13
  • 14. We tend to believe “the truth is in there”, but sometimes it isn’t and the danger is we will find it anyway (c) Stephen Senn 14
  • 15. Causal versus predictive inference • Clinical trials can be used to try and answer a number of very different questions • Two examples are • Did the treatment have an effect in these patients? • A causal purpose • What will the effect be in future patients? • A predictive purpose • Unfortunately, in practice, an answer is produced without stating what the question was • Given certain assumptions these questions can be answered using the same analysis but the assumptions are strong and rarely stated (c) Stephen Senn 15
  • 16. Two models Predictive • The population is taken to be ‘patients in general’ • Of course this really means future patients • They are the ones to whom the treatment will be applied • We treat the patients in the trial as an appropriate selection from this population • This does not require them to be typical but it does require additivity of the treatment effect Causal • We take the patients as fixed • We want to know what the effect was for them • Unfortunately there are missing counterfactuals • What would have happened to control patients given intervention and vice-versa • The population is the population of all possible allocations to the patients studied (c) Stephen Senn 16
  • 17. Coverage probabilities for two questions Predictive Causal (c) Stephen Senn 17 60 trials
  • 18. Part II Technical matters to do with design and inference (c) Stephen Senn 18
  • 19. Trial in asthma Basic situation • Two beta-agonists compared • Zephyr(Z) and Mistral(M) • Block structure has several levels • Different designs will be investigated • Cluster • Parallel group • Cross-over Trial • Each design will be blocked at a different level • NB Each design will collect 6 x 4 x 2 x 7 = 336 measurements of Forced Expiratory Volume in one second (FEV1) Block structure Level Number within higher level Total Number Centre 6 6 Patient 4 24 Episodes 2 48 Measurements 7 336 (c) Stephen Senn 19
  • 20. Block structure • Patients are nested with centres • Episodes are nested within patients • Measurements are nested within episodes • Centres/Patients/Episodes/Measurements (c) Stephen Senn 20 Measurements not shown
  • 21. Possible designs • Cluster randomised • In each centre all the patients either receive Zephyr (Z) or Mistral (M) in both episodes • Three centres are chosen at random to receive Z and three to receive M • Parallel group trial • In each centre half the patients receive Z and half M in both episodes • Two patients per centre are randomly chosen to receive Z and two to receive M • Cross-over trial • For each patient the patient receives M in one episode and Z in another • The order of allocation, ZM or MZ is random (c) Stephen Senn 21
  • 25. Null (skeleton) analysis of variance with Genstat ® Code Output (c) Stephen Senn 25 BLOCKSTRUCTURE Centre/Patient/Episode/Measurement ANOVA
  • 26. Full (skeleton) analysis of variance with Genstat ® Additional Code Output (c) Stephen Senn 26 TREATMENTSTRUCTURE Design[] ANOVA (Here Design[] is a pointer with values corresponding to each of the three designs.)
  • 27. The bottom line • The approach recognises that things vary • Centres, patients episodes • It does not require everything to be balanced • Things that can be eliminated will be eliminated by design • Cross-over trial eliminates patients and centres • Parallel group trial eliminates centres • Cluster randomised eliminates none of these • The measure of uncertainty produced by the analysis will reflected what cannot be eliminated • This requires matching the analysis to the design • Note that Genstat® deals with this formally and automatically. Other packages do not. (c) Stephen Senn 27
  • 28. (c) Stephen Senn 28 To call in the statistician after the experiment is done may be no more than asking him to perform a post-mortem examination: he may be able to say what the experiment died of RA Fisher
  • 29. A genuine example ( a real trial) Hills and Armitage 1979 • A cross-over trial of enuresis • Patients randomised to one of two sequences • Active treatment in period 1 followed by placebo in period 2 • Placebo in period 1 followed by active treatment in period 2 • Treatment periods were 14 days long • Number of dry nights measured (c) Stephen Senn 29
  • 30. Important points to note • Because every patient acts as his own control all patient level covariates (of which there could be thousands and thousands) are perfectly balanced • Differences in these covariates can have no effect on the difference between results under treatment and the results under placebo • However, period level covariates (changes within the lives of patients) could have an effect • My normal practice is to fit a period effect as well as patients effects, however, I shall omit doing so to simplify • The parametric analysis then reduces to what is sometimes called a matched pairs t-test (c) Stephen Senn 30
  • 31. Cross-over trial in Enuresis Two treatment periods of 14 days each 1. Hills, M, Armitage, P. The two-period cross-over clinical trial, British Journal of Clinical Pharmacology 1979; 8: 7-20. (c) Stephen Senn 31
  • 32. Two Parametric Approaches Not fitting patient effect Estimate s.e. t(56) t pr. 2.172 0.964 2.25 0.0282 Fitting patient effect Estimate s.e. t(28) t pr . 2.172 0.616 3.53 0.00147 (c) Stephen Senn Note that ignoring the patient effect, the P-value is less impressive and the standard error is larger The method posts higher uncertainty because unlike the within-patient analysis it make no assumption that the patient level covariates are balanced. Of course, in this case, since we know the patient level covariates are balanced, this analysis is wrong 32
  • 33. Blue diamond shows treatment effect whether we condition on patient or not as a factor. It is identical because the trial is balanced by patient. However the permutation distribution is quite different and our inferences are different whether we condition (red) or not (black) and clearly balancing the randomisation by patient and not conditioning the analysis by patient is wrong (c) Stephen Senn 33
  • 34. The two permutation* distributions summarised Summary statistics for Permuted difference no blocking Number of observations = 10000 • Mean = -0.00319 • Median = -0.0345 • Minimum = -3.621 • Maximum = 3.690 • Lower quartile = -0.655 • Upper quartile = 0.655 Standard deviation = 0.993 P-value for observed difference 0.0344 (Parametric P-value 0.0282) *Strictly speaking, these are randomisation distributions Summary statistics for Permuted difference blocking Number of observations = 10000 • Mean = -0.00339 • Median = 0.0345 • Minimum = -2.793 • Maximum = 2.517 • Lower quartile = -0.517 • Upper quartile = 0.517 P-value for observed difference 0.001 (Parametric P-value 0.00147) (c) Stephen Senn 34
  • 35. What happens if you balance but don’t condition? Approach Variance of estimated treatment effect over all randomisations* Mean of estimated variance of treatment effect over all randomisations* Completely randomised Analysed as such 0.987 0.996 Randomised within-patient Analysed as such 0.534 0.529 Randomised within-patient Analysed as completely randomised 0.534 1.005 *Based on 10000 random permutations (c) Stephen Senn 35 That is to say, permute values respecting the fact that they come from a cross-over but analyse them as if they came from a parallel group trial
  • 36. 36 The difference between mathematical and applied statistics is that the former is full of lemmas whereas the latter is full of dilemmas (c) Stephen Senn
  • 37. The Shocking Truth • The validity of conventional analysis of randomised trials does not depend on covariate balance • It is valid because they are not perfectly balanced • An allowance is already made for things being unbalanced • If they were balanced the standard analysis would be wrong • Like an insurance broker forbidding you to travel abroad in the policy but calculating your premiums on the assumption that you will • This accounts for unobserved covariates. What happens when they are observed? (c) Stephen Senn 2019 37
  • 38. (c) Stephen Senn 2019 • Two dice are rolled – Red die – Black die • You have to call correctly the probability of a total score of 10 • Three variants – Game 1 You call the probability and the dice are rolled together – Game 2 the red die is rolled first, you are shown the score and then must call the probability – Game 3 the red die is rolled first, you are not shown the score and then must call the probability Game of Chance 38
  • 39. (c) Stephen Senn 2019 Total Score when Rolling Two Dice Variant 1. Three of 36 equally likely results give a 10. The probability is 3/36=1/12. 39
  • 40. (c) Stephen Senn 2019 Variant 2: If the red die score is 1,2 or 3, the probability of a total of10 is 0. If the red die score is 4,5 or 6, the probability of a total of10 is 1/6. Variant 3: The probability = (½ x 0) + (½ x 1/6) = 1/12 Total Score when Rolling Two Dice 40
  • 41. The morals Dice games • You can’t treat game 2 like game 1 • You must condition on the information received • You must use the actual data from the red die • You can treat game 3 like game 1 • You can use the distribution in probability that the red die has Inference in general • You can’t use the random behavior of a system to justify ignoring information that arises from the system • That would be to treat game 2 like game 1 • You can use the random behavior of the system to justify ignoring that which has not been seen • You are entitled to treat game 3 like game 1 (c) Stephen Senn 2019 41
  • 42. What does the Rothamsted approach do? • Matches the allocation procedure to the analysis. You can either regard this as meaning • The randomisation you carried out guides the analysis • The analysis you intend guides the randomisation • Or both • Either way, the idea is to avoid inconsistency • Regarding something as being very important at the allocation stage but not at the analysis stage is inconsistent • Permits you not only to take account of things seen but also to make an appropriate allowance for things unseen • Die analogy is that it makes sure that the game is a fair one (c) Stephen Senn 42
  • 43. A simulating example • I am going to simulate 200 clinical trials • Trials are of a bronchodilator against placebo. • Simple randomisation of 50 patients to each arm • I shall have values at outcome and values at baseline • Forced expiratory volume in one second (FEV1) in mL • Parameter settings • True mean under placebo 2200 mL • Under bronchodilator 2500 mL • Treatment effect is 300 mL • SD at outcome and baseline is 150 mL • Correlation is 0.7 (c) Stephen Senn 2019 43
  • 44. Point estimates and confidence intervals Baseline values not available (like game 1) (c) Stephen Senn 2019 44
  • 45. Point estimates and 95% confidence intervals Baseline values available (Game 2) (c) Stephen Senn 2019 45
  • 46. How analysis of covariance works • This shows ANCOVA applied to sample 170 of the 200 simulated • There is an imbalance at baseline • I have adjusted for this by fitting two parallel lines • The difference between the two estimates show how an outcome value would change for a given baseline value if treatments were switched (c) Stephen Senn 2019 46
  • 47. Lessons for big data • We tend to treat observational data-sets as if they were badly randomised parallel group trials but cluster-randomised trials might be a better analogy • True standard errors may be much bigger than estimated ones • See Cox, Kartsonaki & Keogh (2018) and Xiao-Li Meng (2018) • Design matters • Beware of dreams in which mathematics triumphs over biology • You can be rich in data but poor in information (c) Stephen Senn 2019 47
  • 48. A big data analyst is an expert at reaching misleading conclusions with huge data sets, whereas a statistician can do the same with small ones (c) Stephen Senn 48
  • 49. References (c) Stephen Senn 49 D. R. Cox, C. Kartsonaki and R. H. Keogh (2018) Big data: Some statistical issues. Stat Probab Lett, 111- 115. X.-L. Meng (2018) Statistical paradises and paradoxes in big data (I): Law of large populations, big data paradox, and the 2016 US presidential election. The Annals of Applied Statistics, 685-726. S. J. Senn (2013) Seven myths of randomisation in clinical trials. Statistics in Medicine, 1439-1450. S. Senn (2013) A Brief Note Regarding Randomization. Perspectives in biology and medicine, 452-453. S. J. Senn (2019) The well-adjusted statistician. Applied Clinical Trials, June 18. https://www.appliedclinicaltrialsonline.com/view/well-adjusted-statistician-analysis-covariance- explained S. Senn (2019) John Ashworth Nelder. 8 October 1924—7 August 2010: The Royal Society Publishing. A number of blogs on my blog site are also relevant: http://www.senns.uk/Blogs.html