Statistics in biomedical laboratory and clinical science: applications, issues and pitfalls

This review is directed at biomedical scientists who want to gain a better understanding of statistics: what tests to use, when, and why. In my view, even during the planning stage of a study it is very important to seek the advice of a qualified biostatistician. When designing and analyzing a study, it is important to construct and test global hypotheses, rather than to make multiple tests on the data. If the latter cannot be avoided, it is essential to control the risk of making false-positive inferences by applying multiple comparison procedures. For comparing two means or two proportions, it is best to use exact permutation tests rather then the better known, classical, ones. For comparing many means, analysis of variance, often of a complex type, is the most powerful approach. The correlation coefficient should never be used to compare the performances of two methods of measurement, or two measures, because it does not detect bias. Instead the Altman-Bland method of differences or least-products linear regression analysis should be preferred. Finally, the educational value to investigators of interaction with a biostatistician, before, during and after a study, cannot be overemphasized.