title: Mastering variation: variance components and personalised medicine.
abstract: Various sources of variation in observed response in clinical trials and clinical practice are considered, and ways in which the corresponding components of variation might be estimated are discussed. Although the issues have been generally well-covered in the statistical literature, they seem to be poorly understood in the medical literature and even the statistical literature occasionally shows some confusion. To increase understanding and communication, some simple graphical approaches to illustrating issues are proposed. It is also suggested that reducing variation in medical practice might make as big a contribution to improving health outcome as personalising its delivery according to the patient. It is concluded that the common belief that there is a strong personal element in response to treatment is not based on sound statistical evidence.
authors.affiliation: Competence Centre for Methodology and Statistics, Luxembourg Institute of Health, L-1445, Strassen, Luxembourg.
authors.forename: Stephen
authors.identifier: http://orcid.org/0000-0002-7558-8473
authors.initials: S
authors.lastname: Senn
mesh_terms: D000704:Analysis of Variance; D001249:Asthma / Q000503:physiopathology / Q000628:therapy; D056808:Biostatistics; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D003196:Computer Graphics; D003198:Computer Simulation; D018592:Cross-Over Studies; D005541:Forced Expiratory Volume; D006801:Humans; D057285:Precision Medicine / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D014068:Tonsillectomy / Q000706:statistics & numerical data
keywords: components of variation; cross-over trials; n-of-1 trials; personalised medicine; random effects