8.2 – The controversy over proper hypothesis testing

Introduction

Over the next several chapters we will introduce and develop an approach to statistical inference, which has been given the title “Null Hypothesis Significance Testing” or NHST.

In outline, NHST proceeds with

• statements of two hypotheses, a null hypothesis, H_O, and an alternative hypothesis, H_A
• calculate a test statistic comparison of the null hypothesis (assuming some characteristic of data).
• The value of the test statistic is to be compared to a critical value for the test, identified for the assumed probability distribution at associated degrees of freedom for the statistical function, and assigned Type I error rate.

We will expand on these statements later in this chapter, so stay with me here. Basically, the null hypothesis is often a statement like the responses of subjects from the treatment and control groups are the same, eg, no treatment effect. Note that the alternative hypothesis, eg, hypertensive patients receiving hydalazine for six weeks have lower systolic blood pressure than patients receiving a placebo (Campbell et al 2011), would be the scientific hypothesis we are most interested in. But in the Frequentist NHST approach we test the null hypothesis, not the alternative hypothesis. This framework over proper hypothesis testing is the basis of the Bayesian vs Frequentist controversy.

Consider the independent sample t-test (see Chapter 8.5 and 8.6), our first example of a parametric test.

After plugging in the sample means and the standard error for the difference between the means, we calculate t, the test statistic of the t-test. The critical value is treated as a cut-off value in the NHST approach. We have to set our Type I error rate before we start the experiment, and we have available the degrees of freedom for the test, which follows from the sample size. With these in hand, the critical value is found by looking in the t-table of probabilities (or better, use R).

For example, what is the critical value of t-test with 10 degrees of freedom and Type I error of 5%?

In Rcmdr, choose Distributions → Continuous distributions → t distribution → t quantiles… (Fig 1).

Figure 1. Screenshot t-quantiles Rcmdr menu.

Note we want Type I equal to 5%. Since there are two tails for our test, we divide 5% by two and enter 0.025 and select the Upper tail.

R output

> qt(c(.025), df=10, lower.tail=FALSE)
[1] 2.228139

which is the same thing we would get if we look up on the t-distribution table (Fig 2).

Figure 2. Screenshot of portion of t-table with highlighted (red) critical value for 10 degrees of freedom.

If the test statistic is greater than the critical value, then the conclusion is that the null hypothesis is to be provisionally rejected. We would like to conclude that the alternative hypothesis should favored as best description of the results. However, we cannot — the p-value simply tells us how likely our results would be obtained and if the null hypothesis was true. Confusingly, however, you cannot interpret the p-value as telling you the probability (how likely) that the null hypothesis is true. If however the test statistic is less than the critical value, then the conclusion is that the null hypothesis is to be provisionally accepted.

The test statistic can be assigned a probability or p-value. This p-value is judged to be large or small relative to an a priori error probability level cut off called the Type I error rate. Thus, NHST as presented in this way may be thought of as a decision path — if the test statistic is greater than the critical value, which will necessarily mean that the p value is less than the Type I error rate, then we make one type of conclusion (reject H_O). In contrast, if the test statistic is less than the critical value, which will mean that the p-value associated with the test statistic will be greater than the Type I error rate, then we conclude something else about the null hypothesis. The various terms used in this description of NHST were defined in Chapter 8.3.

Sounds confusing, but, you say, OK, what exactly is the controversy? The controversy has to do whether the probability or p-value can be interpreted as evidence for a hypothesis. In one sense, the smaller the p-value, the stronger the case to reject the null hypothesis, right? However, just because the p-value is small — the event is rare — how much evidence do we have that the null hypothesis is true? Not necessarily, and so we can only conclude that the p-value is one part of what we may need for evidence for or against a hypothesis (hint: part of the solution is to consider effect size — introduced in Chapter 9.2 — and the statistical power of the test, see Ch 11). What follows was covered by Goodman (1988) and others. Here’s the problem. Consider tossing a fair coin ten times, with the resulting trial yielding nine out of ten heads (eg, a value of one, with tails equal to zero).

R code

set.seed(938291156)
rbinom(10,1,0.5)
[1] 1 1 1 1 1 1 0 1 1 1

While rare (binomial probability 0.0098), do we take this as evidence that the coin is not fair? By itself, the p-value provides no information about the alternative hypothesis. More about p-value follows below in sections What’s wrong with the p-value from NHST? and The real meaning and interpretation of P-values.

Statisticians have been aware of limitations of the NHST approach for years (see editorial by Wasserstein et al 2019), but only now is the message getting attention of researchers in the biosciences and other fields. In fact, the New York Times recently had a nice piece by F.D. Flam (“The Odds, Continually Updated,” 29 Sep 2014) on the controversy and the Bayesian alternative. Like most controversies there are strong voices on either side, and it can be difficult as an outsider to know which position to side with (Fig 3).

Figure 3. “Frequentists vs. Bayesians,” https://xkcd.com/1132/.

The short answer is — as you go forward do realize that there is a limitation to the frequentist approach and to be on the correct side of the controversy, you need to understand what you can conclude from statistical results. NHST is by far the most commonly used approached in biosciences (eg, out of 49 research articles I checked from four randomly selected issues of 2015 PLoS Biology, 43 used NHST, 2 used a likelihood approach, none used Bayesian statistics). The NHST is also the overwhelming manner in which we teach introductory statistics courses (eg, checking out the various MOOC courses at www.coursera.org, all of the courses related to Basic Statistics or Inferential Statistics are taught primarily from the NHST perspective). However, right from the start I want to emphasize the limits of the NHST approach.

If the purpose of science is to increase knowledge, then the NHST approach by itself is an inadequate framework at best, and in the eyes of some, worthless! Now, I think this latter sentiment is way over the top, but there is a need for us to stop before we begin, in effect, to set the ground rules for what can be interpreted from the NHST approach. The critics of NHST have a very important point, and that needs to be emphasized, but we will also defend use and teaching of this approach so that you are not left with the feeling that somehow this is a waste of time or that you are being cheated from learning the latest knowledge on the subject of statistical inference. The controversy hinges on what probability means.

P-values, statistical power, and replicability of research findings

Science, as a way of knowing how the world works, is the only approach that humans have developed that has been empirically demonstrated to work. Note how I narrowed what science is good for — if we are asking questions about the material world, then science should be your toolkit. Some (eg, Platt 1964), may further argue that there are disciplines in science that have been more successful (eg, molecular biology) than others (eg, evolutionary psychology, cf discussion in Ryle 2006) at advancing our knowledge about the material world. However, to the extent research findings are based solely on statistical results there is reason to believe that many studies in fact have not recovered truth (Ioannidis 2005).

In a review of genomics, it was reported that findings of gene expression differences by many microarray studies were not reproducible (Allison et al 2006). The consensus is that confidence in the findings should hold only for the most abundant gene transcripts of many microarray gene expression profiling studies, a conclusion that undercuts the perceived power of the technology to discover new causes of disease and the basis for individual differences for complex phenotypes. Note that when we write about failure of research reproducibility we are not including cases of alleged fraud (Carlson 2012 on Duke University oncogenomics case), we are instead highlighting that these kinds of studies often lack statistical power; hence, when repeated, the experiments yield different results.

Frequentist and Bayesian Probabilities

Turns out there is a lot of philosophical problems around the idea of “probability,” and three schools of thought. In the Fisherian approach to testing, the researcher devises a null hypothesis, H_O, collects the data, then computes a probability (p-value) of the result or outcome of the experiment. If the p-value is small, then this is inferred as little evidence in support of the null hypothesis.

In the Frequentists’ approach, the one we are calling NHST, the researcher devises two hypotheses, the null hypothesis, H_O, and an alternative hypothesis, H_A. The results are collected from the experiment and, prior to testing, a Type I error rate (α, chance) is defined. The Type I error rate is set to some probability and refers to the chance of rejecting the null hypothesis purely due to random chance. The Frequentist then computes a p-value of result of the experiment and applies a decision criterion: If P-value greater than Type I error rate, then provisionally accept null hypothesis. In both the Fisherian and Frequentist approaches, the probability, again defined at the relative frequency of an event over time, is viewed as a physical, objective and well-defined set of values.

Bayesian approach: based on Bayes conditional probability, one identifies the prior (subjective) probability of an hypothesis, then, adjusts the prior probability (down or up) as new results come in. The adjusted probability is known as posterior probability and it is equal to the likelihood function for the problem. The posterior probability is related to the prior probability and this function can be summarized by the Bayes factor as evidence the evidence against the null hypothesis. And that’s what we want, a metric of our evidence for or against the null hypothesis.

We can calibrate the Bayesian probability to the frequentist p-value (Selke et al 2001; Goodman 2008; Held 2010; Greenland and Poole 2012). Methods to achieve this calibration vary, but the Fagan nomogram Held (2010) proposed is a good tool for us as we go forward. We can calculate our NHST p-value, but then convert the p-value to a Bayes factor by looking at the nomogram. I mention this here not as part of your to do list, but rather as a way past the controversy: the NHST p-value can be interpreted as a Bayesian conditional probability, but they do not test the same hypothesis.

Likelihood

Before we move on there is one more concept to introduce, that of likelihood. We describe a model (an equation) we believe can generate the data we observe. By constructing different models with different parameters (hypotheses), you generate a statistic that yields a likelihood value. If the model fits the data, then the likelihood function has a small value. The basic idea then is to compare related, but different models to see which fits the data better. We will use this approach when comparing linear models when we introduce multiple regression models in Chapter 18.

What’s wrong with the p-value from NHST?

Well, really nothing is “wrong” with the p-value.

Where we tend to get into trouble with the p-value concept is when we try and interpret it. See below, Why is this important to me as a beginning student? The p-value is not evidence for a position, it is a statement about error rates. The p-value from NHST can be viewed as the culmination of a process that is intended to minimize the chance that the statistician makes an error.

In Bayesian terms, the p-value from NHST is the probability that we observe the data (eg, the differences between two sample means), assuming the null hypothesis is true. If we want to interpret the p-value in terms of evidence for a proposition, then we want the conditional error probability.

Sellke et al (2001) provided a calibration of p-values and, assuming that the prior probabilities of the null hypothesis and the alternative hypothesis are equal (that is, that each have a prior probability of 0.5), by using a formula provided by them (equation 3), we can correct our NHST p-value into a probability that can be interpreted as evidence in favor of the interpretation that the null hypothesis is true. In Bayesian terms this is called the posterior probability of the null hypothesis. The formula is

where e is Euler’s number, the base of the natural logarithm (ln), and p is the p-value from the NHST. This calibration works as long as   (Sellke et al 2001).

By convention we set the Type I error at 5% (cf Cohen 1994). How strong of evidence is a p-value near 5% against the null hypothesis being true, again, under the assumption that the prior probability of the null hypothesis being true is 50%? Using the above formula I constructed a plot of the calculated conditional error probability values against p-values (Fig 4).

Figure 4. Conditional error probability values plotted against p-values.

As you can see, a p-value of 5% is not strong evidence at just 0.289. Not until p-values are smaller than 0.004 does the conditional error probability value dip below 0.05, suggesting strong evidence against the null hypothesis being true.

R note: For those of you keeping up with the R work, here’s the code for generating this plot. Text after “#” are comments and are not interpreted by R.

At the R prompt type each line

NHSTp = seq(0.00001,0.37,by=0.01)      #create a sequence of numbers between 0.0001 and 0.37 with a step of 0.01
CEP = (1+(-1*exp(1)*NHSTp*log(NHSTp))^-1)^-1    #equation 3 from Sellke et al 2001
plot(NHSTp,CEP,xlab="P-value", ylab="Conditional error probability",type="l",col="blue")

Why is this important to me as a beginning student?

As we go forward I will be making statements about p-values and Type I error rates and null hypotheses and even such things as false positives and false negative. We need to start to grapple with what exactly can be said by p-values in the context of statistical inference, and to recognize that we will sometimes state conclusions that cut some corners when it comes to interpreting p-values. And yet, you (and all consumers of statistics!) are expected to recognize what p-values mean. Always.

The real meaning and interpretation of P-values

This is as good of a time as any to make some clarification about the meaning of p-value and the whole inference concept. Fisher indeed came up with the concept of the p-value, but its use as a decision criterion owes to others and Fisher disagreed strongly with use of the p-value in this way (Fisher 1955; Lehmann 1993).

Here are some common p-value corner-cutting statements to avoid using (after Goodman 2008; Held 2010). P-values are sometimes interpreted, incorrectly, as

Table. Incorrect interpretations of NHST p-values

1. the probability of obtaining the observed data under the assumption of no real effect
2. an observed type-I error rate
3. the false discovery rate, ie, the probability that a significant finding is a “false positive”
4. the (posterior) probability of the null hypothesis.

So, if p-values don’t mean any of these things, what does a p-value mean? It means that we begin by assuming that there is no effect of our treatments — the p-value is then the chance we will get as large of a result (our test statistic) and the null hypothesis is true. Note that this definition does not include a statement about evidence of the null hypothesis being true. To get evidence of “truth” we need additional tools, like the Bayes Factor and the correction of the p-value to the conditional error probability (see above). Why not dump all of the NHST and go directly to a Bayesian perspective, as some advise? The single best explanation was embedded in the assumption we made about the prior probability in order to calculate the conditional error probability. We assumed the prior probability was 50%. For many, many experiments, that is simply a guess. The truth is we generally don’t know what the prior probability is. Thus, if this assumption is incorrect, then the justification for the formula by Sellke et al (2001) is weakened, and we are no closer to establishing evidence than before.

The take home message is that it is unlikely that a single experiment will provide strong evidence for the truth. Thus the message is repeat your experiments — and you already knew that!  And the Bayesians can tell us that with the addition of more and more data reduces the effect of the particular value of the prior probability on our calculation of the conditional error probability. So, that’s the key to this controversy over the p-value.

Reporting p-values

Estimated p-values can never be zero. Students may come to use software that may return p-values like “0” — I’m looking at you Google Sheets re: default results from CHISQ.TEST() — but again, this does not mean the probability of the result is zero. The software simply reports values to two significant figures and failed to round. Some journals may recommend that 0 should be replaced by p < 0.01 or even < 0.05 inequalities, but the former lacks precision and the latter over-emphasizes the 5% Type I error rate threshold, the “statistical significance” of the result. In general, report p-value to three significant figures and four digits. If a p-value is small, use scientific notation and maintain significant digits. Thus, a p-value of 0.004955794 should be reported as 0.00496 and a p-value of 0.0679 should be reported as 0.0679. Use R’s signif() function, for example p-value reported as 6.334e-05, then

signif(6.334e-05,3)
[1] 6.33e-05

Rounding and significant figures were discussed in Chapter 3.5. See Land and Altman (2015) for guidelines on reporting p-values and other statistical results.

Questions

1. Revisit Figure 1 again and consider the following hypothesis — the sun will rise tomorrow.
   • If we take the Frequentist position, what would the null hypothesis be?
   • If we take the Bayesian approach, identify the prior probability.
   • Which approach, Bayesian or Frequentist, is a better approach for testing this hypothesis?
2. Consider the pediatrician who, upon receiving a chest X-ray for a child notes the left lung has a large irregular opaque area in the lower quadrant. Based on the X-ray and other patient symptoms, the doctor diagnoses pneumonia and prescribes a broad-spectrum antibiotic. Is the doctor behaving as a Frequentist or a Bayesian?
3. With the p-value interpretations listed in the table above in hand, select an article from PLoS Biology, or any of your other favorite research journals, and read how the authors report results of significance testing. Compare the precise wording in the results section against the interpretative phrasing in the discussion section. Do the authors fall into any of the p-value corner-cutting traps?

Quiz Chapter 8.2

The controversy over proper hypothesis testing

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Chapter 8 contents

• Introduction
• The null and alternative hypotheses
• The controversy over proper hypothesis testing<.span>
• Sampling distribution and hypothesis testing
• Tails of a test
• One sample t-test
• Confidence limits for the estimate of population mean
• References and suggested readings

5.3 – Replication, Bias, and Nuisance Variables

Introduction

This page describes additional elements of experimental design, replication and bias, which can impact the validity of a study.

Replication in science refers to repeating an experiment under identical conditions multiple times. To the extent the same conclusions are achieved, we can say the outcome is reproducible (Simmons 2014) and, therefore, likely to be objectively true (Earp 2011). Replication of experimental and sampling units is an essential component of good experimental design. Confusing technical replicates for biological replicates is called pseudoreplication.

Bias refers to any of a number of sociological and cognitive errors which may influence conclusions in science (Ionnidis 2005). In a meta-analysis, Fanelli et al (2017) reported that while the size of effect from identifiable biases were small, some disciplines were more prone to these sources of error. That researchers testing similar hypotheses reach different conclusions may result from bias. One such bias is positive outcome bias, where reports of null hypotheses are more often rejected than they should be based on sample size and other concerns of statistical power (see Chapter 11 – Power analysis).

The page concludes with a discussion of nuisance variables, variables that may be causally associated with the outcome of interest, but themselves are either of no interest in the study, or may not be known in advance (Meehl 1970; see also discussion of spurious correlations in Chapter 16.3 – Data aggregation and correlation).

Technical vs. biological replicates.

A laboratory technician retrieves a vial of an immortalized cell line from cryostorage and initiate propagation of the cells for the week’s work. After a couple of days of subculturing, the technician has grown millions of cells and is ready to set up an assay. After washing the cells in PBS (phosphate buffered saline), the technician adjusts the concentration of cells to 10,000 per mL media, places the tube on ice, and proceeds to set up a 48 well microplate. To each well, the technician adds media, one or more agents (Table 1), plus cells, total volume each well at one mL, three replicates per treatment.

Table 1. In our example there were four treatments plus a control (media only)

• DMSO only (D)
• DMSO + Cytokine (DC)
• DMSO + Small molecule Inhibitor (DS)
• DMSO + Cytokine + Small molecule Inhibitor (DCS)
• Media only (M)

The plate table might look something like Figure 1.

Figure 1. Schematics of a set up for a hypothetical 48 well microplate (plate_plot() from ggplate package).

The technician has done a lot of work; but, from a statistician’s point of view, effectively the technician has but one sampling unit to show for his efforts; one biological sampling unit because as far as we can tell, the cells were all related. Biological replication refers to repeat measures (eg, same conditions) on biologically distinct entities (Blainey et al 2014). Technical replication, in contrast, refers to repeat measures on the same entity, eg, the same individual (Blainey et al 2014).

However, there were more than one technical samples in the experimental design, twelve in all because there were twelve wells. Many of you will recognize this as the distinction between technical and biological replicates. In thinking about experimental design replicates pertain to the number of sampling units that are treated the same way. In our example cells may be “treated the same way” in at least two distinct ways. Biologically, the cells may be the same: derived from the same clonal cell, all at the same passage (generation) number, each cell genetically, morphologically, physiologically (etc.,) identical to the next cell. Technical replication on the other hand pertains to the levels of the treatments.

Within each of these treatments we had three wells, and that’s at the level of the technical replication.

A final note on this experiment. We as molecular biologists call each of these treatment groups, but statisticians thinking of this design would recognize only one treatment (called in statistics a factor), with four levels of the treatment. We will discuss this beginning in chapter 12 when we introduce analysis of variance.

Types of bias.

When we make decisions, we like to think we are rational; that we make decisions based on an evaluation of evidence. And yet, an increasing body of literature suggests that our decisions often made in a manner that falls short of rational processing.  We outlined some sources of bias in Chapter 2.6. Deviance from rational decision making is due to any number of cognitive biases we may have.  Researchers and medical doctors make many decisions and, unfortunately, are just as susceptible to cognitive biases as the rest of us. One kind of bias that is bedeviling to research is confirmatory bias. Confirmatory bias refers to a researcher in effect seeking evidence in a way that confirms a prior conclusion (Kaptchuck 2003). Confirmatory bias would be exhibited if we report positive effects of aspirin to relieve migraines in subjects, but exclude cases where the subjects report no improvement. Medical doctors may be risk averse and therefore tend to over-prescribe, or they may be risk-takers (eg, rise and fall of high-dose chemotherapy, cf, discussion in Howard et al. 2011).

The concept of bias was first introduced in Chapter 3 and will be returned to in subsequent chapters. In general, bias refers to the objectivity of measurement and inferences about such measurements. Bias implies that a series of measurements consistently fail to return the true value of the variable. Bias is systematic error and may be associated with a poorly calibrated instrument or even the use of improper sets of rules for measurement given the nature of the characteristic. Bias can be captured by the concept of accuracy.

Bias is challenging to eliminate; the best way is to design the experiment so that the observer, the researcher, is unaware of the specific questions to be tested. The research is conducted “blind.” Clinical research provides the easiest examples. A trial can be blind in a couple of ways:

• The subjects do not know which treatment they receive, but the researcher does know
• The researcher does not know which treatment subjects receive, but the subjects know
• Neither the researcher nor the subjects know which treatment they receive.
• The other possibility is that both the researcher and the subjects know treatments received — this would be a poor design.

Bias can enter a research project at multiple levels. A partial list of sources of bias in research includes (modified after Pannucci and Wikins 2010):

Bias that occurs before the experiment

• Inadequate planning of the experiment, flawed design
• Bias in selection of subjects from the reference population
• Surveillance bias, where one group is studied more closely than another group.

Surveillance bias, also called detection bias or ascertainment bias, a type of information bias. Characterized as “the more you look, the more you find (Sackett 1979),” differences in outcome counts varies with differences in effort to detect. Recently, cases of myocarditis in young people were reported following Covid-19 mRNA vaccination (eg, Bozkurt et al 2021. Marshall et al 2021). However, myocarditis reports following vaccination occur at the rates expected in the population, and the reports lack important context (eg, other respiratory viruses known to cause myocarditis not ruled out), suggesting the putative link between Covid-19 vaccines and this heart condition may be result of us looking hard for signs of adverse effects of the vaccine (cf, discussion in O’Leary and Maldonado 2021).

Bias during the experiment

• Interviewer bias
• Chronology bias
• Recall bias
• Transfer bias
• Misclassification of exposure or outcome
• Performance bias

Performance bias refers to conditions of an experiment that introduce unintended differences between groups. For example, subjects enrolled in a weight-loss study randomly assigned to the control group may react poorly when they realize they are not receiving the experimental intervention. This leads to potential for a systematic bias — participants in the control group may behave differently, counteracting the point of randomization (McCambridge et al 2014).

Another well-known performance bias is associated with eliciting maximal performance from animals, such as running stamina or maximum sprint running speed (Losos et al 2002). For example, spring running speed of lizards may be measured by placing lizards onto a high-speed treadmill, then increasing belt speed to match the individual’s burst performance (eg, Dohm et al 1998). Clearly, not all individuals will perform to maximum physiological capabilities under these conditions.

Bias after the experiment

• Citation bias
• Confounding

Another way to view sources of bias is that, at least from the perspective of the researcher, the bias is likely to be unconscious bias. After all, if we knew about the sources of bias we would work our experiments in such a way to minimize known error producing sources (Holman et al 2015). Selecting subjects at random and keeping record keeping blind with respect to treatments are among the best tools we have to avoid this kind of bias.

Nuisance variables

A key quality of experimental design is the opportunity afforded the researcher to apply control. In a classic view of the experiment, one allows only one aspect to vary, the treatment applied, all else is controlled. Thus, any difference in outcome may be attributed to the treatment.  However, it is likely impossible to control for all possible variables that may affect our outcome; confounding clear interpretation of results (see Chapter 16.2 and 16.3). Consider, for example, the effects of age on running performance (Fig. 2).

Figure 2. Mean 5K running times (minutes) by age and gender (2006 – 2016, Jamba Juice Banana 5K race, Honolulu, HI).

If we are interested in gender differences, we must also deal with the change in performance with age: older runners regardless of gender tend to run slower than younger runners. Thus, in the comparison of genders, age is a nuisance variable. In the literature, you may see “lurking variable,” or other such names. The concept is that these variables may be causal, but are either of no interest in the study, or may not be known in advance. Therefore, age must be accounted for before we can address gender differences, if any. Age, in this case, is considered a nuisance variable because we are not primarily interested in age effects, but age clearly covaries (is associated) with running performance. How best to handle nuisance variables? One approach is to match by age (blocking effect, see Chapter 14.4); another approach would be to randomly select with respect to age when compiling female and male times.

Another example of confounding. Results from ecological experiments intended to test for presence of competition for resources by plant species by removing plants may alter herbivory levels; thus, survivorship not the result of reduced plant-plant competition but because of changes in herbivore behavior (Reader 1992).

Questions

1. I cite a number of articles in Mike’s Biostatistics Book. If you’re paying attention, you’ll have noticed that all of my citations, at least for articles, link to a source that you can either download or read online. What kind of error am I committing by following this approach?
2. In large part because of the tendency for overuse of antibiotics, doctors are less likely today to prescribe antibiotics for patients with upper respiratory tract infections than in the past (Zoorob et al 2012). URTI are mostly caused by rhinovirus infections (Calderaro et al 2022) and, therefore, the course of infection in a patient should be unaffected by addition of antibiotic. However, although rare compared to URTI, life-threatening illness like acute epiglottitis caused by bacteria infection can sometimes develop or accompany URTI. Thus, not prescribing antibiotics at a diagnosis of URTI may risk a worsening condition for the patients. This sets the doctor up for a potential cognitive bias – to prescribe or not to prescribe antibiotics prophylactically? Discuss this decision in the context of potential sources of cognitive biases and possible outcomes of the decision.

Quiz Chapter 5.3

Replication, bias, and nuisance variables

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Chapter 5 contents

• The basics explained
• Experiments
• Experimental and Sampling units
• Replication, Bias, and Nuisance Variables
• Clinical trials
• Importance of randomization in experimental design
• Sampling from Populations
• References and suggested readings