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How Doctors Judge Whether a Medical Study Can Be Trusted

1The Clinical Question and Why Study Design Follows From It2Randomization, Allocation, and the Logic of Comparison3Blinding, Follow-Up, and Who Actually Got Analyzed4Reading the Result: Effect Size, Uncertainty, and Significance5Applicability: Does This Result Fit My Patient?6Combining Studies and Forming a Verdict
Applicability: Does This Result Fit My Patient?

Adjusting expected benefit to your patient's baseline risk

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Set the trial's relative risk reduction to thirty percent and leave it there. Now move the patient's baseline risk slider. At a baseline risk of two percent, the absolute risk reduction is small and the number needed to treat is large. Raise the baseline risk to twenty percent and the absolute risk reduction grows tenfold while the number needed to treat falls to a fraction of its former value. The relative effect never changed; only the patient's starting risk did. That is the adjustment you make when deciding whether a trial result applies to the patient in front of you.
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A trial reports a relative effect, such as a relative risk reduction, that is roughly constant across risk levels. The absolute benefit your patient can expect is that relative effect multiplied by the patient's own baseline risk. Because the relative effect is fixed, the absolute benefit scales directly with baseline risk: a patient at twice the risk of the trial average stands to gain roughly twice the absolute benefit, and a patient at half the risk stands to gain roughly half.

This is why the same trial result can justify treatment in one patient and not another. The number needed to treat is the reciprocal of the absolute risk reduction, so it falls as baseline risk rises. The simulation lets you set the trial's relative risk reduction and your patient's baseline risk, then read the resulting absolute risk reduction and number needed to treat. The relationship is linear in baseline risk, and the practical question is whether the patient's risk is high enough that the absolute benefit outweighs the harms and burden of treatment.

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