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There is a long honoured tradition in a number of specialities, and sub-specialities, of knowing The Landmark Trials. The studies that demonstrated that something works or that some method is better than another.<\/p>\nThere is a long honoured tradition in a number of specialities, and sub-specialities, of knowing The Landmark Trials. The studies that demonstrated that something works or that some method is better than another.<\/p>\n
But Landmark Trials are bunkum.<\/p>\n
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There’s a couple of problems with Landmark Trials though; firstly –\u00a0the general rule is that the earliest trials in a subject show report much greater effects than later ones. This has been demonstrated in a fair few examples – including this classic from 1998 showing that the in\u00a0non-significant studies is greater than\u00a0delay tends to be in\u00a0significant ones:<\/p>\n
(doi:10.1001\/jama.279.4.281)<\/p>\n In terms of effects and time, then this ‘cinnamon in diabetes’ review is fascinating – it’s arranges in chronological order of publication:<\/p>\n (doi: 10.1370\/afm.1517 – ignore that meta-analytic diamond by the way – it’s meaningless – the I-sq <\/a>is 84%)<\/span><\/p>\n But perhaps the greatest example of why we should destroy the edifice of the Landmark Trial is this huge analysis by the genius of John P. A. Ioannidis<\/a>, who took about a decade’s worth of studies from major journals\u00a0that had been cited over 1000 times, and looked to see what the subsequent studies showed. His\u00a0conclusion was<\/p>\n “Contradiction and initially stronger effects are not unusual in highly cited research of clinical interventions and their outcomes.”<\/em><\/p><\/blockquote>\n Only 44% of these ‘Landmark’ studies ended up having subsequent studies confirming the size and direction of effect they had found.<\/p>\n Of course, it’s interesting to know what led us to do what we do. But let’s not make the ‘Landmark Trial’ a\u00a0thing of clinical importance; systematic reviews are what should guide our practice.<\/a>\u00a0Landmark trials are just for the historian in us.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" There is a long honoured tradition in a number of specialities, and sub-specialities, of knowing The Landmark Trials. The studies that demonstrated that something works or that some method is better than another. But Landmark Trials are bunkum. […]<\/p>\n![\"Picture1\"](\"https:\/\/stg-blogs.bmj.com\/adc\/files\/2016\/03\/Picture1-300x157.png\")
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