not all that shines is gold as an
expression that sometimes we use to
refer to things that look real when
they’re actually not it might be true
about people it might be true about
places sometimes events but it’s also
true about some research not all
published research is gold and the truth
is I’m a professor I’m a researcher I do
research and teach research so don’t get
me wrong research is very important I’m
a very strong believer in the importance
of research to advance informed decision
making in practice professions it’s very
important to advance evidence-based
practice but research is not immune to
error every research study is prone to a
degree of error we refer to it as random
error or systematic error random error
is a fancy word for a chance error we
assume that it’s benign it does not have
an impact on our conclusions about
reality and I agree with that we tend to
be forgiving with regards to random
error systematic error however refers to
bias and by a
is not so benign buyers can impact our
understanding of reality it can lead us
to make inferences about things they’re
not there are not necessarily true
so to understand the issue of bias we
need to realize that there are several
sources of bias in research the one
source of bias I want to talk about
today is the confounding bias to better
understand confounding bias we need to
think about who we are as humans we do
not exist in vacuum we are variable clip
for instance our health estate if I come
to you and I say your health state is a
function of your dietary lifestyle
I’m telling you part of the picture
because your health state is not a mere
function of your diet your diet might be
a small factor that influences your
health estate your genes can also
influence your health estate your age
can influence your health estate your
exercise and activity can influence your
health estate therefore it’s important
when I want to understand the impact of
diet on health estate that we also
account for other factors that might
influence this relationship things don’t
exist in vacuum because if they do I can
easily convince you that the shoe size
of a school-age child will predict his
or her level of education and if things
exist in very
you I can also easily convince you that
those who carry a cigarette lighter are
at higher risk for acquiring lung cancer
how come let’s look at the example of
shoe size and level of education when
pigs exist in vacuum that I will support
that but what’s missing is the age of a
child as a matter of fact an older child
will have a larger shoe size and an
older child will also have a higher
level of education age causes both the
larger shoe size and the advancement in
education and that’s the classic
definition of confounder it’s a variable
that confounds the cause and the effect
confounders are two types they can be
complete and they can be partial I
mentioned the example of cigarette
lighter and lung cancer that doesn’t
make any sense to anybody and that’s why
it’s a complete confounded relationship
completely confounded relationship why
because it’s a function of smoking when
we ignore smoking we in fear that having
a cigarette lighter will cause someone
to increase his or her risk for lung
cancer now let’s put smoking in the
equation we know that smokers are more
likely than non-smokers to carry a
cigarette lighter and we know that
smokers are at higher risk to develop
lung cancer control for smoking and this
relationship will vanish it doesn’t
exist
confounders can also be partial
for instance again smoking and lung
cancer but now the smoking status is the
exposing factor smoking is not the only
thing that increases one’s risk for lung
cancer I’ll take one possible confounder
there could be several but let’s
consider age the older you are the older
people are the more likely they’ve
become smokers and then the older you
are the more likely you are to develop
lung cancer when we adjust for age maybe
the relationship between smoking and
lung cancer worse t the difference is
the margin of the relationship fins it
becomes smaller so to understand the
real relationships about things we have
to keep in mind that relationships could
be confounded and we shouldn’t ignore
that now you might say I’m bringing
these fictitious examples because I’m
trying to be extreme with regards to
these explanations truth is the research
data publications and reports are
plagued with confounded relationships in
this era of commercialization in this
academic atmosphere where we have to
publish or perish sometimes we become or
we succumb to the temptation and ignore
confounded relationships I’m gonna share
with you an example of a study that I
found a little troubling so the study is
about tree pollen and the increased risk
of nonviolence
suicide and
women so the title of the study is that
three Pauline Peaks are associated will
increase nonviolent suicide in women the
study intrigued me I actually went and
read the study and I found that the
authors of the study examined all kinds
of relationships they examined men and
women they examined nonviolent and
violent suicide and they also included
all types of pollens but the one single
significant relationship in the study
suddenly made itself to the title of the
study I want you to think what makes
three Pauline lead women to learn violet
suicide sometimes we know the confounder
and other times we may never know it you
might just be left for guessing so
confounding is a problem and we have to
handle it but how do we handle it we
need to be aware that research studies
are two types they’re either
observational in nature or experimental
in nature we refer to them in clinical
settings as clinical trials and
observational studies we can never
completely eliminate confounding because
we can only control for what we know
however we have to be real about what we
know if I know that variables X Y & Z
confound the relationship in my study I
need to see evidence that the
researchers have controlled for them
they have accounted for them otherwise
you are left to doubt the level of
evidence if the study is a randomized
control trial or experimental in nature
we have to understand that by virtue
over
damas Asian meaning we give people equal
chance to be assigned to one or the
other group in the study we equate the
groups on all confounders the ones we
know and the ones we may not know by
virtue of randomization we accomplish
that so confounding seems to be a list
of a problem and well conducted
randomized control trials where do we go
from here we have to become informed
consumers and utilizers of research
research is very important but only when
it’s will conducted and only when the
evidence in it is made of diamond we
have to be the diamond that resists the
pressure of temptation if we are
researchers we have to resist the
pressure of ignoring confounding because
it suits our presumed ideas and if we
are utilizers we have to resist the
pressure of ignoring confounding because
the results suit my liking thank you
very much
[Applause]
expression that sometimes we use to
refer to things that look real when
they’re actually not it might be true
about people it might be true about
places sometimes events but it’s also
true about some research not all
published research is gold and the truth
is I’m a professor I’m a researcher I do
research and teach research so don’t get
me wrong research is very important I’m
a very strong believer in the importance
of research to advance informed decision
making in practice professions it’s very
important to advance evidence-based
practice but research is not immune to
error every research study is prone to a
degree of error we refer to it as random
error or systematic error random error
is a fancy word for a chance error we
assume that it’s benign it does not have
an impact on our conclusions about
reality and I agree with that we tend to
be forgiving with regards to random
error systematic error however refers to
bias and by a
is not so benign buyers can impact our
understanding of reality it can lead us
to make inferences about things they’re
not there are not necessarily true
so to understand the issue of bias we
need to realize that there are several
sources of bias in research the one
source of bias I want to talk about
today is the confounding bias to better
understand confounding bias we need to
think about who we are as humans we do
not exist in vacuum we are variable clip
for instance our health estate if I come
to you and I say your health state is a
function of your dietary lifestyle
I’m telling you part of the picture
because your health state is not a mere
function of your diet your diet might be
a small factor that influences your
health estate your genes can also
influence your health estate your age
can influence your health estate your
exercise and activity can influence your
health estate therefore it’s important
when I want to understand the impact of
diet on health estate that we also
account for other factors that might
influence this relationship things don’t
exist in vacuum because if they do I can
easily convince you that the shoe size
of a school-age child will predict his
or her level of education and if things
exist in very
you I can also easily convince you that
those who carry a cigarette lighter are
at higher risk for acquiring lung cancer
how come let’s look at the example of
shoe size and level of education when
pigs exist in vacuum that I will support
that but what’s missing is the age of a
child as a matter of fact an older child
will have a larger shoe size and an
older child will also have a higher
level of education age causes both the
larger shoe size and the advancement in
education and that’s the classic
definition of confounder it’s a variable
that confounds the cause and the effect
confounders are two types they can be
complete and they can be partial I
mentioned the example of cigarette
lighter and lung cancer that doesn’t
make any sense to anybody and that’s why
it’s a complete confounded relationship
completely confounded relationship why
because it’s a function of smoking when
we ignore smoking we in fear that having
a cigarette lighter will cause someone
to increase his or her risk for lung
cancer now let’s put smoking in the
equation we know that smokers are more
likely than non-smokers to carry a
cigarette lighter and we know that
smokers are at higher risk to develop
lung cancer control for smoking and this
relationship will vanish it doesn’t
exist
confounders can also be partial
for instance again smoking and lung
cancer but now the smoking status is the
exposing factor smoking is not the only
thing that increases one’s risk for lung
cancer I’ll take one possible confounder
there could be several but let’s
consider age the older you are the older
people are the more likely they’ve
become smokers and then the older you
are the more likely you are to develop
lung cancer when we adjust for age maybe
the relationship between smoking and
lung cancer worse t the difference is
the margin of the relationship fins it
becomes smaller so to understand the
real relationships about things we have
to keep in mind that relationships could
be confounded and we shouldn’t ignore
that now you might say I’m bringing
these fictitious examples because I’m
trying to be extreme with regards to
these explanations truth is the research
data publications and reports are
plagued with confounded relationships in
this era of commercialization in this
academic atmosphere where we have to
publish or perish sometimes we become or
we succumb to the temptation and ignore
confounded relationships I’m gonna share
with you an example of a study that I
found a little troubling so the study is
about tree pollen and the increased risk
of nonviolence
suicide and
women so the title of the study is that
three Pauline Peaks are associated will
increase nonviolent suicide in women the
study intrigued me I actually went and
read the study and I found that the
authors of the study examined all kinds
of relationships they examined men and
women they examined nonviolent and
violent suicide and they also included
all types of pollens but the one single
significant relationship in the study
suddenly made itself to the title of the
study I want you to think what makes
three Pauline lead women to learn violet
suicide sometimes we know the confounder
and other times we may never know it you
might just be left for guessing so
confounding is a problem and we have to
handle it but how do we handle it we
need to be aware that research studies
are two types they’re either
observational in nature or experimental
in nature we refer to them in clinical
settings as clinical trials and
observational studies we can never
completely eliminate confounding because
we can only control for what we know
however we have to be real about what we
know if I know that variables X Y & Z
confound the relationship in my study I
need to see evidence that the
researchers have controlled for them
they have accounted for them otherwise
you are left to doubt the level of
evidence if the study is a randomized
control trial or experimental in nature
we have to understand that by virtue
over
damas Asian meaning we give people equal
chance to be assigned to one or the
other group in the study we equate the
groups on all confounders the ones we
know and the ones we may not know by
virtue of randomization we accomplish
that so confounding seems to be a list
of a problem and well conducted
randomized control trials where do we go
from here we have to become informed
consumers and utilizers of research
research is very important but only when
it’s will conducted and only when the
evidence in it is made of diamond we
have to be the diamond that resists the
pressure of temptation if we are
researchers we have to resist the
pressure of ignoring confounding because
it suits our presumed ideas and if we
are utilizers we have to resist the
pressure of ignoring confounding because
the results suit my liking thank you
very much
[Applause]
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