The experience in the FDA's Center for Devices and Radiological Health with Bayesian strategies.
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Biomedical subjects
Publications and source records attributed to Gregory Campbell.
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This discussion considers arguments for and against separating responsibility for the unblinded interim analysis of a clinical trial from responsibility for trial management and modifications to the ongoing trial. The degree to which one or different statisticians carry out these responsibilities and thus the degree of statistician independence for the two activities can vary, but a sponsor should recognize that giving a single statistician both responsibilities might limit flexibility in managing the trial, particularly with respect to modifying an ongoing trial.
The genomics revolution is reverberating throughout the worlds of pharmaceutical drugs, genetic testing and statistical science. This revolution, which uses single nucleotide polymorphisms (SNPs) and gene expression technology, including cDNA and oligonucleotide microarrays, for a range of tests from home-brews to high-complexity lab kits, can allow the selection or exclusion of patients for therapy (responders or poor metabolizers). The wide variety of US regulatory mechanisms for these tests is discussed. Clinical studies to evaluate the performance of such tests need to follow statistical principles for sound diagnostic test design. Statistical methodology to evaluate such studies can be wide ranging, including receiver operating characteristic (ROC) methodology, logistic regression, discriminant analysis, multiple comparison procedures resampling, Bayesian hierarchical modeling, recursive partitioning, as well as exploratory techniques such as data mining. Recent examples of approved genetic tests are discussed.
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In the last 2 decades major advances have been made in the field of assessment methods for medical imaging and computer-assist systems through the use of the paradigm of the receiver operating characteristic (ROC) curve. In the most recent decade this methodology was extended to embrace the complication of reader variability through advances in the multiple-reader, multiple-case (MRMC) ROC measurement and analysis paradigm. Although this approach has been widely adopted by the imaging research community, some investigators appear averse to it, possibly from concern that it could place a greater burden on the scarce resources of patient cases and readers compared to the requirements of alternative methods. The present communication argues, however, that the MRMC ROC approach to assessment in the context of reader variability may be the most resource-efficient approach available. Moreover, alternative approaches may also be statistically uninterpretable with regard to estimated summary measures of performance and their uncertainties. The authors propose that the MRMC ROC approach be considered even more widely by the larger community with responsibilities for the introduction and dissemination of medical imaging technologies to society. General principles of study design are reviewed, and important contemporary clinical trials are used as examples.