Projects and Experience
When Numbers Count
Often order of magnitude estimates may be sufficient to put a disease or condition in context, determine priorities, or plan a research program. However there are times when having the best available information, and understanding the limitations of that information, is critically important, e.g.
1. http://www.theguardian.com/society/2015/aug/21/dementia-not-growing-epidemic-portrayed-say-academics
2. Wu YT, Fratiglioni L, Matthews FE, et. al. Dementia in western Europe: epidemiological evidence and implications for policy making. Lancet Neurol. 2016 Jan;15(1):116-24.
3. Satizabal CL, Beiser AS, Chouraki V, et. al. Incidence of Dementia over Three Decades in the Framingham Heart Study. NEJM 2016 Feb 11;374(6):523-32.
When Numbers Count
Often order of magnitude estimates may be sufficient to put a disease or condition in context, determine priorities, or plan a research program. However there are times when having the best available information, and understanding the limitations of that information, is critically important, e.g.
- Clinical trials that require a major investment may be underpowered, particularly in research intensive therapeutic areas with studies of long duration and/or rapidly advancing standards of care.
- Estimating the occurrence of a rare condition, e.g. for an orphan drug indication, is challenging. Definitions, criteria for diagnosis, and diagnostic tools are likely to be underdeveloped, and available estimates are likely to be highly variable.
- Estimates for common conditions also have their limitations, e.g. UK NHS dementia targets need to be reassessed as prevalence declined by 20%, possibly due to better prevention and treatment of chronic conditions.1,2 In the US Framingham Heart Study dementia incidence declined by 44% after 30 years; risk was only reduced in those with at least a high school diploma.3
1. http://www.theguardian.com/society/2015/aug/21/dementia-not-growing-epidemic-portrayed-say-academics
2. Wu YT, Fratiglioni L, Matthews FE, et. al. Dementia in western Europe: epidemiological evidence and implications for policy making. Lancet Neurol. 2016 Jan;15(1):116-24.
3. Satizabal CL, Beiser AS, Chouraki V, et. al. Incidence of Dementia over Three Decades in the Framingham Heart Study. NEJM 2016 Feb 11;374(6):523-32.