An exploratory test for an excess of significant findings.
BACKGROUND
The published clinical research literature may be distorted by the pursuit of statistically significant results.


OBJECTIVE
We aimed to develop a test to explore biases stemming from the pursuit of nominal statistical significance.


METHODS
The exploratory test evaluates whether there is a relative excess of formally significant findings in the published literature due to any reason (e.g., publication bias, selective analyses and outcome reporting, or fabricated data). The number of expected studies with statistically significant results is estimated and compared against the number of observed significant studies. The main application uses alpha = 0.05, but a range of alpha thresholds is also examined. Different values or prior distributions of the effect size are assumed. Given the typically low power (few studies per research question), the test may be best applied across domains of many meta-analyses that share common characteristics (interventions, outcomes, study populations, research environment).


RESULTS
We evaluated illustratively eight meta-analyses of clinical trials with >50 studies each and 10 meta-analyses of clinical efficacy for neuroleptic agents in schizophrenia; the 10 meta-analyses were also examined as a composite domain. Different results were obtained against commonly used tests of publication bias. We demonstrated a clear or possible excess of significant studies in 6 of 8 large meta-analyses and in the wide domain of neuroleptic treatments.


CONCLUSIONS
The proposed test is exploratory, may depend on prior assumptions, and should be applied cautiously.


CONCLUSIONS
An excess of significant findings may be documented in some clinical research fields.
Ioannidis
John P A
JP
Clinical Trials and Evidence Based Medicine Unit and Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. jioannid@cc.uoi.gr
Trikalinos
Thomas A
TA
D014150:Antipsychotic Agents / Q000627:therapeutic use; D015982:Bias; D002986:Clinical Trials as Topic / Q000379:methods* / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D006801:Humans; D015201:Meta-Analysis as Topic; D011336:Probability; D012559:Schizophrenia / Q000188:drug therapy
D014150:Antipsychotic Agents