Reporting clinical trials from the viewpoint of a patient's choice of treatment

Those who report a clinical trial should acknowledge the right of the ‘consumer’ to make decisions based on his own valuation of the beneficial and adverse effects which rival treatments may have. Suppose a new patient is inclined to trade one unit of benefit for c units of complication. Then he should (should not) be given the treatment if his estimated utility gain, χ 1 ‐ c χ 2 , is positive (negative) and statistically significant according to the data of the trial: here χ 1 ( χ 2 ) denotes the observed average benefit (complication level). If the estimated gain is not statistically significant, the data do not allow any firm recommendation. This c‐dependent recommendation in general cannot be determined from inspection of a joint confidence region for the two means concerned. Therefore investigators should present the outcome of the significance test as a function of c (inverted inference). Typically there are several types of adverse effect or benefit, in which case the quantity c must be generalized into a vector of personal relative utility weights.