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So much agree from me on this comment! Absolutely an individual outcome in a context has its own degree of bias - and it's higher if it's subjective/unreliable/without a solid research basis that it measures what it claims to measure/manipulable... And subjective outcome measures have a higher...

I wish your first point was true! There are many other potential sources of bias - what a particular practitioner (or more) did that deviated from the protocol, things going differently at one hospital versus another... And then all the things that can go wrong with the report (selective outcome...

...which would count as a value from the trial (that it raised questions about other evidence for you, I mean). It provided data on adverse effects, and that's an unusually large sample size of women for that non-surgical treatment. (Since there is not only a single relevant trial, a single...

I'd said I would do this, but when I re-read this carefully, I don't think it's that simple. Even when trials are blinded, and even when the outcomes aren't subjective, results can be distorted by factors not strictly related to the treatment. In terms of your final question, I'd want more...

I don't believe I suggested that. Quite early on, I said I had trouble with the statement as it stood, and explained why people would disagree with it, but thanks for clarifying. I still don't agree, but yes, I disagree with that version a lot less! :geek: That said, however, I see that...

Apologies that my answer won't cover everything you mean. Sometimes, pain is a pivotal issue - when 2 options are roughly equal in all other known respects, for example, if one of the procedures hurts more than the other, it's critical for a lot of people's decision making - and certainly for...

Thank you - that's nice, and I appreciate it! Oh yes, you can definitely count on me engaging robustly with Cochrane and others, and not being easy to push around or deter. It's hard when people you don't know, and who don't know you, have so much power in a particular situation that matters...

Thanks - that's nice! Not my first rodeo - and there's Twitter, which is a whole other level, and I do that. I never would have agreed to lead the IAG if I wasn't prepared to be serious about engagement.

OK, but can't do it right now - have to work.

I didn't think of that word as emotive, but happy to replace with another and won't keep using it. Global? All-encompassing? I totally agree that derogatory words are a barrier to discussion, and I look forward to not being on the receiving end of slanging, even though I have a far higher...

Unfortunately, Cochrane quality control of what it publishes even in Cochrane reviews isn't all it needs to be. I don't think it's necessarily better in its blogs or the blogs of organizations it supports. (Nor should it censor people's opinions.)

The thing I've been debating is partly whether subjective outcomes in an unblinded treatment trial can ever justifiably be a primary endpoint, but more importantly this part of what he said - that if it's not, the trial is valueless (not just that particular bit of outcome data): If Jonathan...

However, I did just prove that I didn't have an epidural "...the trial might still have some value...I don't think anyone is suggesting otherwise": actually, the point I was responding to was someone saying exactly that, and that anyone who disagreed with the statement was either incompetent...

Well, that'll teach me to use an obstetrics example without getting up-to-date on it first - in terms of whether you could have the epidural early you & Trish get to say "OK boomer" about that! :wtf: But that wasn't a trial of placebo epidurals for pain relief: they all had pain relief until the...

I'm glad you're finding it helpful - thanks! And I'll check that out - thanks! Epidurals are done late in labor for a variety of reasons, so that's when it needs to be tested, and it needs to be tested on the type of pain it's meant to relieve. (The C-section aspect was because of the question...

Somewhat similar, just more complicated. (That could be my answer to everything, eh?, "it's complicated"!)

I've replied elsewhere on the subject of trials being collections of data of unequal quality, so I won't reiterate that I don't think a problem in one area necessarily mean other parts of a trial aren't valuable (although there are problems that can systematically affect everything). But I...

I agree with you in terms of being concerned with how some are approaching priority-setting, and that it could lead to a drift towards the priorities of trialists and those of the people who commission and pay for trials. (But just as a point: it's not supposed to be prioritized by the needs of...

Yeah, that's a really good point - but there's a lot of diversity opinion about individual trials, and not every review for example only includes randomized trials either. What's more, quality isn't only a feature of the trial as a whole: the quality of evidence varies within a trial. (Here's a...

Dismissing the trial as valueless is the problem: for example, why would the fact that women were asked to rate their own pain mean the data on impact on cesarean section rate was valueless? (Not that I am saying it would be ok to disregard women's reports of their pain, their discomfort during...