Are all significant P values created equal? The analogy between diagnostic tests and clinical research

Abstract

Just as diagnostic tests are most helpful in light of the clinical presentation, statistical tests are most useful in the context of scientific knowledge. Knowing the specificity and sensitivity of a diagnostic test is necessary, but insufficient: the clinician must also estimate the prior probability of the disease. In the same way, knowing thePvalue and power, or the confidence interval, for the results of a research study is necessary but insufficient: the reader must estimate the prior probability that the research hypothesis is true. Just as a positive diagnostic test does not mean that a patient has the disease, especially if the clinical picture suggests otherwise, a significantPvalue does not mean that a research hypothesis is correct, especially if it is inconsistent with current knowledge. Powerful studies are like sensitive tests in that they can be especially useful when the results are negative. Very lowPvalues are like very specific tests; both result in few false-positive results due to chance. This Bayesian approach can clarify much of the confusion surrounding the use and interpretation of statistical tests. (JAMA1987;257:2459-2463)