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General Practice

Multiple significance tests: the Bonferroni method

BMJ 1995; 310 doi: (Published 21 January 1995) Cite this as: BMJ 1995;310:170
  1. J Martin Bland, reader in medical statisticsa,
  2. Douglas G Altman, headb
  1. a Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE
  2. b Medical Statistics Laboratory, Imperial Cancer Research Fund, London WC2A 3PX

    Many published papers include large numbers of significance tests. These may be difficult to interpret because if we go on testing long enough we will inevitably find something which is “significant.” We must beware of attaching too much importance to a lone significant result among a mass of non-significant ones. It may be the one in 20 which we expect by chance alone.

    Lee et al simulated a clinical trial of the treatment of coronary artery disease by allocating 1073 patient records from past cases into two “treatment” groups at random.1 They then analysed the outcome as if it were a genuine trial of two treatments. The analysis was quite detailed and thorough. As we would expect, it failed to show any significant difference in survival between those patients allocated to the two treatments. Patients were then subdivided by two variables which affect prognosis, the number of diseased coronary vessels and whether the left ventricular contraction pattern was normal or abnormal. A significant difference in survival between the two “treatment” groups was found in those patients with three diseased vessels (the maximum) and abnormal ventricular contraction. As this would be the subset of patients with the worst prognosis, the finding would be easy to account for by saying that the superior “treatment” …

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