December 2018 Journal Club

Hi Everyone

This months paper can be found here :


“Hi Everyone

Hope you enjoyed the paper!

I thought I’d end the year on a philosophical note by raising the concept of the fragility index (this is summarised beautifully here ( but if you don’t fancy clicking there; in essence it’s a tool to help see past the p-values and confidence intervals that bedeck research papers. An appreciation of the fragility index also helps us to understand why statistical significance doesn’t always translate into clinical significance.


This month’s paper demonstrates that a large majority of critical care trials have a low fragility index i.e. the statistical significance hinges upon only a few clinical data points (sometimes only 1!) which to be honest shouldn’t come as a surprise because on the whole critical care trials tend to be small. It also calls for researchers to publish their fragility index in addition to a p value to help clinicians make a better judgments about the “robustness” of the evidence; and therefore whether or not to incorporate it into their practice.


So is this just another nail in the coffin for EBM? Is it evidence that “experts” are hoodwinking us with statistical fireworks in order to get a paper published? Is the general zeitgeist of “expert bashing” justified? Shall we form a mob?


I would argue, emphatically, no.

In fact this paper highlights why we need experts to guide us and how important they are to making things better. How many of you knew about fragility indexes before this group of “experts” published the paper? Now we know about it we can look for it (it is starting to be included into publications) and next time you are at a conference and someone puts up some statistically significant result what’s to stop you asking what the fragility index is?

Knowledge is only as good as the facts on which it is based and science is wonderful because it gives us a tool to generate facts (rather than opinions or truths) from which to build knowledge up, one tiny piece at a time. It’s a slow laborious process that can obviously be manipulated to serve egotistical aims but rarely is because we have “experts” like these to help us navigate the ocean of data out there and identify the real facts from the not so real………..

Knowing that is incredibly reassuring and inspiring and it’s not just in medicine there are good people everywhere doing their bit to promote “factfulness” (

So there we go, hope you found that useful and if nothing else please remember to be “factful” because if you do I’m sure our patients will benefit……..



ps the term factfulness was promoted by the late, great Dr Hans Rosling. If you are after a bit of inspiration check out his TED talks!”

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