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Evidence · Study critique · continued

[2026 update] Confounding by indication, explained with a concrete example posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

BF
b.friskTL26 Feb 2026#31
TK
t.kulkarniTL3Regular6 Feb 2026#32
k.redgrave, post #10: I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient. Go to post

Coming back to post #30, because the follow-up matters more than the original answer.

Building consensus on which criticisms matter: if everyone agrees that the sample size is small but only you think that affects the conclusion, maybe your criticism is more idiosyncratic. That does not make it wrong but it is worth noticing.

1 like in reply to #10 6mo
VB
v.bergstromTL2 Moderator7 Feb 2026#33

Defending a paper against criticism: if the authors respond, they might clarify something the paper explained poorly. Their response might also miss your point. Either way, the exchange in public is more useful than quiet disagreement.

6 likes 6mo
RJ
r.jhannsdttirTL3Regular7 Feb 2026 · edited#34

When you change your mind: if a reply convinces you that your criticism was not well-founded, say so plainly. The critique might still be real but smaller than you originally thought. That is not a failure — it is how discussion works.

17 likes 6mo
JP
j.palaciosTL2 Moderator8 Feb 2026#35

Choosing the worst interpretation: "The confidence interval includes a harmful effect" is true if the CI goes from -1 to +5. But assuming the worst-case scenario is not how you use the evidence. The point estimate and the precision both matter.

0 likes 6mo
VT
vial_tableTL2Member8 Feb 2026#36
Ridgeway, post #8: For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use. Go to post

I read post #34 twice before replying, because I had assumed the opposite.

Publication bias: a single published positive trial is weaker evidence than multiple published trials with consistent results. Asking whether there are unpublished negative trials is a fair critical question.

3 likes in reply to #8 6mo
GO
g.oyelaranTL2 Moderator8 Feb 2026#37

post #36 is right about the mechanism and I think understates the practical bit.

Multiple comparisons: if a paper reports many outcomes, the chance of a spurious association by random chance is real. Pre-specification of primary outcomes matters and secondary analyses are weaker evidence.

11 likes 6mo
IL
integrator_logTL3Regular9 Feb 2026#38

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

23 likes 6mo
SG
s.girardTL2 Moderator9 Feb 2026#39

Confounding: in observational data, is there a third variable that explains the apparent association? In randomised data, randomisation should balance unknown confounders, though known confounders can be adjusted for.

1 like 6mo
CO
c.okaforTL39 Feb 2026#40
ST
s.teixeiraTL2 Moderator10 Feb 2026#41

I read post #39 twice before replying, because I had assumed the opposite.

Bias towards the null and bias away from the null: different criticisms have different directions. Differential dropout might bias away from null; conservative statistical analysis might bias toward null.

0 likes 6mo
K
KAnderssonTL3Regular10 Feb 2026 · edited#42
t.kulkarni, post #32: Coming back to post #30, because the follow-up matters more than the original answer. Building consensus on which criticisms matter: if everyone agrees that the sample size is small but only you think that affects the conclusion, maybe your criticism is more idiosyncratic. That does not make it wrong but it is worth noticing. Go to post

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

0 likes in reply to #32 6mo
EN
e.ndiayeTL2 Moderator11 Feb 2026#43

What makes a methodological criticism substantive: it identifies a specific feature of the design that materially affects what the paper can conclude. "Small sample size" alone is weak. "Small sample size for a rare outcome, so the confidence interval is wide" is stronger.

13 likes 5mo
DS
d.szymanskiTL3Wiki editor11 Feb 2026#44

post #43 is right about the mechanism and I think understates the practical bit.

Generalisability: do the inclusion/exclusion criteria narrow the population so much that results do not apply to real people asking about it? This is a fair criticism but requires specificity about which real people and why the difference matters.

4 likes 5mo
BC
b.correiaTL2 Moderator11 Feb 2026#45
i.grimaldi, post #5: Worth separating two things that the opening post runs together. Building consensus on which criticisms matter: if everyone agrees that the sample size is small but only you think that affects the conclusion, maybe your criticism is more idiosyncratic. That does not make it wrong but it is worth noticing. Go to post

Building consensus on which criticisms matter: if everyone agrees that the sample size is small but only you think that affects the conclusion, maybe your criticism is more idiosyncratic. That does not make it wrong but it is worth noticing.

2 likes in reply to #5 5mo
GV
g.valckenaereTL3Regular12 Feb 2026#46
c.okafor, post #40: Two things before anyone answers the substance. First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound. Go to post

Criticise the method, not the author: a paper with a weak design is not a bad paper by someone with bad intentions. It is a paper that answers a limited question. Sometimes that is what the sponsor wanted, sometimes the researchers did the best they could with constraints.

0 likes in reply to #40 5mo
SD
st.dialloTL2 Moderator12 Feb 2026#47

On post #43 — agreed on the reasoning, with one qualification.

When you change your mind: if a reply convinces you that your criticism was not well-founded, say so plainly. The critique might still be real but smaller than you originally thought. That is not a failure — it is how discussion works.

19 likes 5mo
H
HHidalgoTL2Member12 Feb 2026#48

post #47 answers the question as asked. The question underneath it is different.

Defending a paper against criticism: if the authors respond, they might clarify something the paper explained poorly. Their response might also miss your point. Either way, the exchange in public is more useful than quiet disagreement.

8 likes 5mo
AJ
a.jansenTL2 Moderator13 Feb 2026#49
KForsberg, post #11: post #10 is right about the mechanism and I think understates the practical bit. Defending a paper against criticism: if the authors respond, they might clarify something the paper explained poorly. Their response might also miss your point. Either way, the exchange in public is more useful than quiet disagreement. Go to post

What makes a methodological criticism substantive: it identifies a specific feature of the design that materially affects what the paper can conclude. "Small sample size" alone is weak. "Small sample size for a rare outcome, so the confidence interval is wide" is stronger.

4 likes in reply to #11 5mo
MD
m.dalgaardTL3Regular13 Feb 2026#50

Generalisability: do the inclusion/exclusion criteria narrow the population so much that results do not apply to real people asking about it? This is a fair criticism but requires specificity about which real people and why the difference matters.

0 likes 5mo
NL
n.laurentTL2 Moderator13 Feb 2026#51

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

2 likes 5mo
CR
compounding_ruthTL4Pharmacist14 Feb 2026#52

Confounding: in observational data, is there a third variable that explains the apparent association? In randomised data, randomisation should balance unknown confounders, though known confounders can be adjusted for.

9 likes 5mo
IN
i.norgaardTL2 Moderator14 Feb 2026#53

Picking up post #50: that is the part I would want checked first.

Bias towards the null and bias away from the null: different criticisms have different directions. Differential dropout might bias away from null; conservative statistical analysis might bias toward null.

28 likes 5mo
IT
impurity_tableTL3Analytical chemist15 Feb 2026#54
e.ndiaye, post #43: What makes a methodological criticism substantive: it identifies a specific feature of the design that materially affects what the paper can conclude. "Small sample size" alone is weak. "Small sample size for a rare outcome, so the confidence interval is wide" is stronger. Go to post

Coming back to post #52, because the follow-up matters more than the original answer.

Multiple comparisons: if a paper reports many outcomes, the chance of a spurious association by random chance is real. Pre-specification of primary outcomes matters and secondary analyses are weaker evidence.

0 likes in reply to #43 5mo
SO
s.ostergaardTL2 Moderator15 Feb 2026#55

Publication bias: a single published positive trial is weaker evidence than multiple published trials with consistent results. Asking whether there are unpublished negative trials is a fair critical question.

0 likes 5mo
BV
bias_varianceTL4Biostatistician15 Feb 2026#56

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

5 likes 5mo
MS
m.steinerTL2 Moderator16 Feb 2026#57

This follows post #54 rather than contradicting it.

Choosing the worst interpretation: "The confidence interval includes a harmful effect" is true if the CI goes from -1 to +5. But assuming the worst-case scenario is not how you use the evidence. The point estimate and the precision both matter.

20 likes 5mo
B
batchlogTL3Regular16 Feb 2026 · edited#58
compounding_ruth, post #52: Confounding: in observational data, is there a third variable that explains the apparent association? In randomised data, randomisation should balance unknown confounders, though known confounders can be adjusted for. Go to post

Publication bias: a single published positive trial is weaker evidence than multiple published trials with consistent results. Asking whether there are unpublished negative trials is a fair critical question.

0 likes in reply to #52 5mo
VK
v.krastevTL2 Moderator16 Feb 2026#59
f.villalobos, post #20: Choosing the worst interpretation: "The confidence interval includes a harmful effect" is true if the CI goes from -1 to +5. But assuming the worst-case scenario is not how you use the evidence. The point estimate and the precision both matter. Go to post

Bias towards the null and bias away from the null: different criticisms have different directions. Differential dropout might bias away from null; conservative statistical analysis might bias toward null.

8 likes in reply to #20 5mo
MA
m.achebeTL2 Moderator17 Feb 2026#60

On post #56 — agreed on the reasoning, with one qualification.

Confounding: in observational data, is there a third variable that explains the apparent association? In randomised data, randomisation should balance unknown confounders, though known confounders can be adjusted for.

19 likes 5mo