Evidence map›Paper›PMID 15595946›Full record

ArticleThe Milbank quarterly2004

Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages.

Richard L Kravitz, Naihua Duan, Joel Braslow

Erratum issuedOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Milbank quarterly, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 202 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
202citing papers in PubMed, 5 pooled it
48.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

202 citing papers in PubMed, 5 syntheses or guidelines pooled it, 605 citations in OpenAlex.

  1. Pooled it
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  3. N-of-1 Randomized Intervention Trials in Health Psychology: A Systematic Review and Methodology Critique.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2018
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  7. Variability in resistance training trajectories of breast cancer patients undergoing therapy.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024
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142 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

  • Erratum issued
5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Richard L KravitzUniversity of California, Davis, CA, USA. rlkravitz@ucdavis.edu
Naihua Duan
Joel Braslow
University of California, Los Angeles · USUniversity of California System · US

Funding

UCLA Rapid, Relevant, Rigorous Implementation Science HubP30MH058107 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI RAPHAEL J LANDOVITZ · 1997 to 2026
$53.5M
Consumer Influences of Treatment of DepressionR01MH064683 · NIMH · UNIVERSITY OF CALIFORNIA DAVIS · PI KRAVITZ, RICHARD L · 2002 to 2004
$2.1M
NIMH NIH HHS P30 MH058107NIMH NIH HHS P-30 MH58107NIMH NIH HHS R01 MH064683NIMH NIH HHS R01 MH64683-01A1
6 · The paper itself

Abstract

Evidence-based medicine is the application of scientific evidence to clinical practice. This article discusses the difficulties of applying global evidence ("average effects" measured as population means) to local problems (individual patients or groups who might depart from the population average). It argues that the benefit or harm of most treatments in clinical trials can be misleading and fail to reveal the potentially complex mixture of substantial benefits for some, little benefit for many, and harm for a few. Heterogeneity of treatment effects reflects patient diversity in risk of disease, responsiveness to treatment, vulnerability to adverse effects, and utility for different outcomes. Recognizing these factors, researchers can design studies that better characterize who will benefit from medical treatments, and clinicians and policymakers can make better use of the results.

Indexed as

Evidence-Based MedicineDrug ApprovalHumansPolicy MakingPractice Patterns, Physicians'Randomized Controlled Trials as TopicTreatment OutcomeUnited StatesUnited States Food and Drug Administration

Identifiers

PMID15595946
PMCPMC2690188
OpenAlexW2164821482

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.