The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Editorial

Navigating the Pendulum Swings in Surgery: Historical Shifts and Lessons for Modern Practice

Authors: Ali Cadili MD, MSc, MBA

Abstract

The concept of statistical significance is central to the modern foundation of the evidence-based medicine era. Inordinate reliance on P values and confidence intervals, without deliberate reflection on their limitations and context, however, may mask their true associations. Far too often, nonstatistically significant trends in initial studies are later validated as significant in subsequent larger, more adequately powered investigations. Central to these perpetuating cycles of rejection and reembracement are underpowered trials, which are inherently susceptible to type II errors, and thus frequently fail to detect genuine effects. This recurring motif in medical history reveals an important truth about the current framework of clinical research and statistical inference-namely, that it is imperfect and heavily reliant on foundational assumptions.

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