What's wrong with Bonferroni adjustments

BMJ 1998;316:1236-1238 ( 18 April )

Education and debate

What's wrong with Bonferroni adjustments

Thomas V Perneger, medical epidemiologist.

Institute of Social and Preventive Medicine, University of Geneva, CH-1211 Geneva 4, Switzerland

Correspondence to: Dr Perneger perneger@cmu.unige.ch

The first 150 words of the full text of this article appear below.

When more than one statistical test is performed in analysing the data from a clinical study, some statisticians and journaleditors demand that a more stringent criterion be used for "statisticalsignificance" than the conventional P<0.05.¹ Many well meaningresearchers, eager for methodological rigour, comply without fullygrasping what is at stake. Recently, adjustments for multipletests (or Bonferroni adjustments) have found their way into introductorytexts on medical statistics, which has increased their apparentlegitimacy. This paper advances the view, widely heldby epidemiologists, that Bonferroni adjustments are, at best,unnecessary and, at worst, deleterious to sound statistical inference.

Table Removed (Available Only in the Full Text)

	Adjustment for multiple tests

Bonferroni adjustments are based on the following reasoning.^1-3 If a null hypothesis is true (for instance, two treatmentgroups in a randomised trial do not differ in terms of cure rates),a significant difference (P<0.05) will be observed by chance oncein 20 trials. This is the type I error, or $alpha$ . . . [Full text of this article]

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LeBlanc, J. C., Pless, I. B., King, W. J., Bawden, H., Bernard-Bonnin, A.-C., Klassen, T., Tenenbein, M. (2006). Home safety measures and the risk of unintentional injury among young children: a multicentre case-control study. CMAJ 175: 883-887 [Abstract] [Full text]
Kasner, S. E., Lynn, M. J., Chimowitz, M. I., Frankel, M. R., Howlett-Smith, H., Hertzberg, V. S., Chaturvedi, S., Levine, S. R., Stern, B. J., Benesch, C. G., Jovin, T. G., Sila, C. A., Romano, J. G., for the Warfarin Aspirin Symptomatic Intracranial, (2006). Warfarin vs aspirin for symptomatic intracranial stenosis: Subgroup analyses from WASID.. Neurology 67: 1275-1278 [Abstract] [Full text]
Shelton, R. J., Clark, A. L., Goode, K., Rigby, A. S., Cleland, J. G.F. (2006). The diagnostic utility of N-terminal pro-B-type natriuretic peptide for the detection of major structural heart disease in patients with atrial fibrillation. Eur Heart J 27: 2353-2361 [Abstract] [Full text]
Benzinou, M., Walley, A., Lobbens, S., Charles, M.-A., Jouret, B., Fumeron, F., Balkau, B., Meyre, D., Froguel, P. (2006). Bardet-biedl syndrome gene variants are associated with both childhood and adult common obesity in French Caucasians.. Diabetes 55: 2876-2882 [Abstract] [Full text]
Witte, K K A, Nikitin, N P, Cleland, J G F, Clark, A L (2006). Excessive breathlessness in patients with diastolic heart failure. Heart 92: 1425-1429 [Abstract] [Full text]
Laurvick, C. L., Msall, M. E., Silburn, S., Bower, C., Klerk, N. d., Leonard, H. (2006). Physical and Mental Health of Mothers Caring for a Child With Rett Syndrome. Pediatrics 118: e1152-e1164 [Abstract] [Full text]