Hidden Bias in Research Design

Lawrence D. Grouse, MD, PhD
JAMA. 1980;243(13):1365. doi:10.1001/jama.1980.03300390049024.
Text Size: A A A
Published online


I believe that most physicians have had the experience of seeing patients with what are generally considered serious diseases— diseases associated with substantial mortality or morbidity according to the textbooks—and were surprised at how many of these patients do remarkably well, not appearing to follow the morbid textbook course at all. Seen, perhaps, for some minor, unrelated problem, their serious disease may remain totally quiescent, indefinitely. Such experiences make one doubtful of the accuracy of original diagnoses or, in moments of skepticism, make one wonder whether patients referred to academic centers do worse than unreferred (and unreported) cases for reasons other than the pathophysiology of their disease.

An article published in this issue of The Journal by Ellenberg and Nelson (p 1337) may shed some light on this paradox. When studying children with febrile seizures, these investigators find that clinic-based studies may have reported on a biased spectrum of patients.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.