{"id":1265,"date":"2016-03-11T20:33:39","date_gmt":"2016-03-11T19:33:39","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=1265"},"modified":"2016-03-02T15:04:30","modified_gmt":"2016-03-02T14:04:30","slug":"basics-blame-it-on-me","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/","title":{"rendered":"Basics: Blame it on me"},"content":{"rendered":"<p>In my clinical role, it&#8217;s fairly easy to take the blame for most bad things that happen to my patients. I give them cytotoxic chemotherapy (for good reason, honest) and it&#8217;s a group of substances that we label with TERATOGENIC! HARMFUL! QUITE BAD FOR YOU! tags a lot of the time.<\/p>\n<p>But how do we know, in most circumstances, if the \u00a0drug\/potion\/puffer etc is the cause of something averse?\u00a0<!--more--><\/p>\n<p>The basic tenets of appraisal for such an study\u00a0are about assembling an appropriate group, and making fair assessments of outcomes &#8211; much as every other type of study.<\/p>\n<p>You&#8217;d like to see that<\/p>\n<ul>\n<li>the exposed &amp; unexposed groups were broadly comparable<\/li>\n<li>the outcomes and <a href=\"https:\/\/blogs.bmj.com\/adc\/2009\/02\/13\/confused-by-confounding\/\">confounding <\/a>variables were measured the same way<\/li>\n<li>the follow-up was long enough to have seen the outcome happen<\/li>\n<\/ul>\n<p>These try to see if there&#8217;s something else in the patient\/group that is the &#8217;cause&#8217; of the poor outcomes, that it&#8217;s not just that one group got extra-hard looking-at, and that we waited long enough to see if it was bad or not.<\/p>\n<p>There are some additional, common-sense type questions that need to be asked too:<\/p>\n<ul>\n<li>did exposure-to-harm-causing-agent really happen before the harm was caused?<\/li>\n<li>is there a dose-response gradient? (mostly this is found)<\/li>\n<li>is there challenge-rechallenge data? (if it happens three times, it&#8217;s pretty much that it did happen)<\/li>\n<li>is the association consistent across studies? (that&#8217;s consistent &#8211; not identical &#8211; or is this a one-off finding in one study?)<\/li>\n<li>does the association make biological sense? (bearing in mind that biological sense is often rewritten when we see things that didn&#8217;t make sense until we explained them &#8230;)<\/li>\n<\/ul>\n<p>Now the idea way of getting comparable groups is randomisation, but if the events are rare or temporally late from giving the drug, it&#8217;s not going to catch them. It might be that large cohorts, or case-control studies are needed instead. For exceptionally rare events, then\u00a0collections of cases (without formal controls) may be sufficient to show the harms caused.<\/p>\n<p>&#8216;Blaming&#8217; is always difficult, but these appraisal pointers may be of some use in unpicking the strength of evidence behind the attributions.<\/p>\n<p>&#8211; Archi<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In my clinical role, it&#8217;s fairly easy to take the blame for most bad things that happen to my patients. I give them cytotoxic chemotherapy (for good reason, honest) and it&#8217;s a group of substances that we label with TERATOGENIC! HARMFUL! QUITE BAD FOR YOU! tags a lot of the time. But how do we [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79,80],"tags":[],"class_list":["post-1265","post","type-post","status-publish","format-standard","hentry","category-archimedes","category-critical-appraisal-note"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Basics: Blame it on me - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Basics: Blame it on me - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"In my clinical role, it&#8217;s fairly easy to take the blame for most bad things that happen to my patients. I give them cytotoxic chemotherapy (for good reason, honest) and it&#8217;s a group of substances that we label with TERATOGENIC! HARMFUL! QUITE BAD FOR YOU! tags a lot of the time. But how do we [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/\" \/>\n<meta property=\"og:site_name\" content=\"ADC Online Blog\" \/>\n<meta property=\"article:published_time\" content=\"2016-03-11T19:33:39+00:00\" \/>\n<meta name=\"author\" content=\"Bob Phillips\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bob Phillips\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/\"},\"author\":{\"name\":\"Bob Phillips\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/person\\\/9e94029681ecf36e73bbd1eb2be2ef94\"},\"headline\":\"Basics: Blame it on me\",\"datePublished\":\"2016-03-11T19:33:39+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/\"},\"wordCount\":371,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#organization\"},\"articleSection\":[\"archimedes\",\"critical appraisal note\"],\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/\",\"name\":\"Basics: Blame it on me - ADC Online Blog\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#website\"},\"datePublished\":\"2016-03-11T19:33:39+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2016\\\/03\\\/11\\\/basics-blame-it-on-me\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Basics: Blame it on me\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/\",\"name\":\"ADC Online Blog\",\"description\":\"Education, debate, and meandering thoughts on child health, using evidence and research.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#organization\",\"name\":\"ADC Online Blog\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/files\\\/2017\\\/10\\\/blog-logo-adc.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/files\\\/2017\\\/10\\\/blog-logo-adc.png\",\"width\":285,\"height\":34,\"caption\":\"ADC Online Blog\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/person\\\/9e94029681ecf36e73bbd1eb2be2ef94\",\"name\":\"Bob Phillips\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/9ce6165c429dd8d36e6532db799ebe58e6f9c614c44e05e60d553e4bac662441?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/9ce6165c429dd8d36e6532db799ebe58e6f9c614c44e05e60d553e4bac662441?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/9ce6165c429dd8d36e6532db799ebe58e6f9c614c44e05e60d553e4bac662441?s=96&d=mm&r=g\",\"caption\":\"Bob Phillips\"},\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/author\\\/bphillips\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Basics: Blame it on me - ADC Online Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/","og_locale":"en_GB","og_type":"article","og_title":"Basics: Blame it on me - ADC Online Blog","og_description":"In my clinical role, it&#8217;s fairly easy to take the blame for most bad things that happen to my patients. I give them cytotoxic chemotherapy (for good reason, honest) and it&#8217;s a group of substances that we label with TERATOGENIC! HARMFUL! QUITE BAD FOR YOU! tags a lot of the time. But how do we [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/","og_site_name":"ADC Online Blog","article_published_time":"2016-03-11T19:33:39+00:00","author":"Bob Phillips","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Bob Phillips","Estimated reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/"},"author":{"name":"Bob Phillips","@id":"https:\/\/blogs.bmj.com\/adc\/#\/schema\/person\/9e94029681ecf36e73bbd1eb2be2ef94"},"headline":"Basics: Blame it on me","datePublished":"2016-03-11T19:33:39+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/"},"wordCount":371,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/adc\/#organization"},"articleSection":["archimedes","critical appraisal note"],"inLanguage":"en-GB","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/","url":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/","name":"Basics: Blame it on me - ADC Online Blog","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/adc\/#website"},"datePublished":"2016-03-11T19:33:39+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/#breadcrumb"},"inLanguage":"en-GB","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/adc\/2016\/03\/11\/basics-blame-it-on-me\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/adc\/"},{"@type":"ListItem","position":2,"name":"Basics: Blame it on me"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/adc\/#website","url":"https:\/\/blogs.bmj.com\/adc\/","name":"ADC Online Blog","description":"Education, debate, and meandering thoughts on child health, using evidence and research.","publisher":{"@id":"https:\/\/blogs.bmj.com\/adc\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/adc\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-GB"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/adc\/#organization","name":"ADC Online Blog","url":"https:\/\/blogs.bmj.com\/adc\/","logo":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/blogs.bmj.com\/adc\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/adc\/files\/2017\/10\/blog-logo-adc.png","contentUrl":"https:\/\/blogs.bmj.com\/adc\/files\/2017\/10\/blog-logo-adc.png","width":285,"height":34,"caption":"ADC Online Blog"},"image":{"@id":"https:\/\/blogs.bmj.com\/adc\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/adc\/#\/schema\/person\/9e94029681ecf36e73bbd1eb2be2ef94","name":"Bob Phillips","image":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/secure.gravatar.com\/avatar\/9ce6165c429dd8d36e6532db799ebe58e6f9c614c44e05e60d553e4bac662441?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/9ce6165c429dd8d36e6532db799ebe58e6f9c614c44e05e60d553e4bac662441?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/9ce6165c429dd8d36e6532db799ebe58e6f9c614c44e05e60d553e4bac662441?s=96&d=mm&r=g","caption":"Bob Phillips"},"url":"https:\/\/blogs.bmj.com\/adc\/author\/bphillips\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/1265","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=1265"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/1265\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=1265"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=1265"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=1265"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}