(T\u00e1c gi\u1ea3: TS.BS. John P. A. Ioannidis. Quan \u0111i\u1ec3m y khoa \u0111\u0103ng tr\u00ean JAMA ng\u00e0y 22\/3\/2018)<\/p>\n
Gi\u00e1 tr\u1ecb P v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m \u0111\u1ecbnh m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea k\u00e8m theo n\u00f3 \u0111ang t\u1ea1o ra nh\u1eefng th\u00e1ch th\u1ee9c trong y sinh h\u1ecdc v\u00e0 nhi\u1ec1u chuy\u00ean ng\u00e0nh kh\u00e1c. Tuy\u1ec7t \u0111\u1ea1i \u0111a s\u1ed1 (96%) c\u00e1c b\u00e0i b\u00e1o c\u00f3 b\u00e1o c\u00e1o gi\u00e1 tr\u1ecb P nh\u1ecf h\u01a1n ho\u1eb7c b\u1eb1ng 0,05 trong ph\u1ea7n t\u00f3m t\u1eaft, to\u00e0n v\u0103n ho\u1eb7c c\u1ea3 hai ph\u1ea7n n\u00e0y [1]. Tuy nhi\u00ean, trong s\u1ed1 c\u00e1c kh\u1eb3ng \u0111\u1ecbnh m\u00e0 c\u00e1c b\u00e0i b\u00e1o n\u00e0y \u0111\u01b0a ra, nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p r\u1ea5t c\u00f3 th\u1ec3 l\u00e0 sai l\u1ea7m [2]. Nh\u1eadn th\u1ea5y t\u1ea7m quan tr\u1ecdng to l\u1edbn c\u1ee7a c\u00e2u \u0111\u1ed1 v\u1ec1 m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea, Hi\u1ec7p h\u1ed9i Th\u1ed1ng k\u00ea Hoa K\u00ec (ASA) \u0111\u00e3 cho \u0111\u0103ng t\u1ea3i m\u1ed9t ph\u00e1t ng\u00f4n v\u1ec1 gi\u00e1 tr\u1ecb P n\u0103m 2016. Nhi\u1ec1u ng\u01b0\u1eddi tin r\u1eb1ng c\u00f2n ph\u1ea3i b\u00e0n c\u00e3i v\u1ec1 th\u1ef1c tr\u1ea1ng v\u1ea5n \u0111\u1ec1 n\u00e0y, nh\u01b0ng v\u1ec1 c\u00e1ch th\u1ee9c \u0111\u00fang \u0111\u1eafn \u0111\u1ec3 gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 th\u00ec c\u00f2n qu\u00e1 nhi\u1ec1u tranh c\u00e3i. C\u00e1c t\u00e1c gi\u1ea3 c\u1ee7a ph\u00e1t ng\u00f4n ASA c\u0169ng \u0111\u00e3 vi\u1ebft 20 ch\u00fa th\u00edch \u0111\u1ed9c l\u1eadp k\u00e8m theo, t\u1eadp trung v\u00e0o c\u00e1c kh\u00eda c\u1ea1nh kh\u00e1c nhau v\u00e0 \u01b0u ti\u00ean cho m\u1ed9t s\u1ed1 gi\u1ea3i ph\u00e1p. M\u1ed9t nh\u00f3m l\u1edbn kh\u00e1c, g\u1ed3m 72 nh\u00e0 khoa h\u1ecdc v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u, g\u1ea7n \u0111\u00e2y c\u0169ng \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t m\u1ed9t h\u01b0\u1edbng \u0111i c\u1ee5 th\u1ec3 v\u00e0 \u0111\u01a1n gi\u1ea3n: \u0111\u00f3 l\u00e0 h\u1ea1 th\u1ea5p ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb P th\u01b0\u1eddng d\u00f9ng cho vi\u1ec7c kh\u1eb3ng \u0111\u1ecbnh m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea, t\u1eeb 0,05 c\u00f2n 0,005, \u0111\u1ed1i v\u1edbi c\u00e1c ph\u00e1t hi\u1ec7n m\u1edbi. \u0110\u1ec1 xu\u1ea5t \u0111\u00e3 nh\u1eadn \u0111\u01b0\u1ee3c s\u1ef1 t\u00e1n \u0111\u1ed3ng m\u1ea1nh m\u1ebd c\u0169ng nh\u01b0 quan ng\u1ea1i \u1edf c\u00e1c c\u1ed9ng \u0111\u1ed3ng khoa h\u1ecdc kh\u00e1c nhau.<\/p>\n
Hi\u1ec7n nay gi\u00e1 tr\u1ecb P b\u1ecb hi\u1ec3u sai, c\u1ea3 tin c\u0169ng nh\u01b0 l\u1ea1m d\u1ee5ng. Nh\u1eefng c\u00e2u t\u1eeb c\u1ee7a ph\u00e1t ng\u00f4n ASA m\u1ed5 x\u1ebb r\u00f5 h\u01a1n 3 v\u1ea5n \u0111\u1ec1 n\u00e0y. C\u00f3 r\u1ea5t nhi\u1ec1u c\u00e1ch hi\u1ec3u sai v\u1ec1 gi\u00e1 tr\u1ecb P, nh\u01b0ng ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 gi\u00e1 tr\u1ecb n\u00e0y \u0111\u1ea1i di\u1ec7n cho \u201cx\u00e1c su\u1ea5t \u0111\u1ec3 gi\u1ea3 thuy\u1ebft nghi\u00ean c\u1ee9u l\u00e0 \u0111\u00fang\u201d [3]. Gi\u00e1 tr\u1ecb P b\u1eb1ng 0,02 (2%) b\u1ecb xem x\u00e9t m\u1ed9t c\u00e1ch sai l\u1ea7m theo ngh\u0129a r\u1eb1ng gi\u1ea3 thuy\u1ebft kh\u00f4ng (H0) (v\u00ed d\u1ee5, thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 gi\u1ea3 d\u01b0\u1ee3c) c\u00f3 x\u00e1c su\u1ea5t 2% l\u00e0 \u0111\u00fang v\u00e0 \u0111\u1ed1i thuy\u1ebft (v\u00ed d\u1ee5, thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n gi\u1ea3 d\u01b0\u1ee3c) c\u00f3 x\u00e1c su\u1ea5t 98% l\u00e0 \u0111\u00fang. S\u1ef1 c\u1ea3 tin ngh\u0129a l\u00e0 khi ng\u01b0\u1eddi ta qu\u00ean \u0111i r\u1eb1ng suy lu\u1eadn h\u1ee3p l\u00ed c\u1ea7n c\u00f3 th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7 (full reporting) v\u00e0 s\u1ef1 t\u01b0\u1eddng minh (transparency)\u201d [3]. B\u1ea3n th\u00e2n gi\u00e1 tr\u1ecb P \u0111\u1eb9p (c\u00e0ng nh\u1ecf) kh\u00f4ng \u0111\u1ea3m b\u1ea3o cho vi\u1ec7c th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7 v\u00e0 s\u1ef1 t\u01b0\u1eddng minh. Th\u1ef1c t\u1ebf, gi\u00e1 tr\u1ecb P c\u00e0ng nh\u1ecf l\u1ea1i c\u00f3 th\u1ec3 g\u1ee3i \u00fd vi\u1ec7c th\u00f4ng tin ch\u1ecdn l\u1ecdc (selective reporting) v\u00e0 s\u1ef1 kh\u00f4ng t\u01b0\u1eddng minh (nontransparency). Hi\u1ec7n t\u01b0\u1ee3ng l\u1ea1m d\u1ee5ng gi\u00e1 tr\u1ecb P ph\u1ed5 bi\u1ebfn l\u00e0 \u0111\u01b0a ra \u201cc\u00e1c k\u1ebft lu\u1eadn khoa h\u1ecdc v\u00e0 quy\u1ebft \u0111\u1ecbnh th\u01b0\u01a1ng v\u1ee5 ho\u1eb7c ch\u00ednh s\u00e1ch\u201d d\u1ef1a tr\u00ean vi\u1ec7c \u201cgi\u00e1 tr\u1ecb P c\u00f3 v\u01b0\u1ee3t qua m\u1ed9t ng\u01b0\u1ee1ng c\u1ee5 th\u1ec3 kh\u00f4ng\u201d m\u1eb7c d\u00f9 \u201cgi\u00e1 tr\u1ecb P, hay m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea, kh\u00f4ng \u0111o l\u01b0\u1eddng m\u1ee9c \u0111\u1ed9 c\u1ee7a \u1ea3nh h\u01b0\u1edfng hay t\u1ea7m quan tr\u1ecdng c\u1ee7a k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u\u201d v\u00e0 \u201cb\u1ea3n th\u00e2n gi\u00e1 tr\u1ecb P kh\u00f4ng ph\u1ea3i l\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00fang v\u1ec1 b\u1eb1ng ch\u1ee9ng\u201d [3].
\nBa v\u1ea5n \u0111\u1ec1 l\u1edbn n\u00eau tr\u00ean cho th\u1ea5y vi\u1ec7c v\u01b0\u1ee3t qua m\u1ed9t ng\u01b0\u1ee1ng m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea (v\u1eabn hay d\u00f9ng l\u00e0 P=0,05) ho\u00e0n to\u00e0n kh\u00f4ng \u0111\u1ed3ng ngh\u0129a v\u1edbi vi\u1ec7c m\u1ed9t ph\u00e1t hi\u1ec7n ho\u1eb7c k\u1ebft qu\u1ea3 (v\u00ed d\u1ee5 m\u1ed9t m\u1ed1i li\u00ean h\u1ec7 ho\u1eb7c t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb) l\u00e0 \u0111\u00fang, x\u00e1c th\u1ef1c v\u00e0 \u0111\u00e1ng \u0111\u1ec3 \u0111\u01b0a ra h\u00e0nh \u0111\u1ed9ng. C\u00e1c c\u00e1ch hi\u1ec3u sai n\u00e0y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u, c\u00e1c b\u00e0i b\u00e1o v\u00e0 ng\u01b0\u1eddi s\u1eed d\u1ee5ng c\u00e1c b\u00e0i b\u00e1o nghi\u00ean c\u1ee9u, th\u1eadm ch\u00ed l\u00e0 gi\u1edbi truy\u1ec1n th\u00f4ng v\u00e0 c\u1ed9ng \u0111\u1ed3ng s\u1eed d\u1ee5ng th\u00f4ng tin khoa h\u1ecdc. H\u1ea7u h\u1ebft c\u00e1c kh\u1eb3ng \u0111\u1ecbnh \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi m\u1ed9t gi\u00e1 tr\u1ecb P h\u01a1i th\u1ea5p h\u01a1n so v\u1edbi 0,05 r\u1ea5t c\u00f3 th\u1ec3 l\u00e0 sai l\u1ea7m (ngh\u0129a l\u00e0 kh\u00f4ng h\u1ec1 c\u00f3 m\u1ed1i li\u00ean h\u1ec7 v\u00e0 t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh). K\u1ec3 c\u1ea3 trong s\u1ed1 nh\u1eefng kh\u1eb3ng \u0111\u1ecbnh th\u1ef1c s\u1ef1 l\u00e0 \u0111\u00fang, c\u0169ng c\u00f3 r\u1ea5t \u00edt kh\u1eb3ng \u0111\u1ecbnh \u0111\u00e1ng \u0111\u1ec3 \u0111\u01b0a ra h\u00e0nh \u0111\u1ed9ng v\u1ec1 y khoa v\u00e0 ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe.<\/p>\n
H\u1ea1 th\u1ea5p ng\u01b0\u1ee1ng kh\u1eb3ng \u0111\u1ecbnh m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea l\u00e0 \u00fd t\u01b0\u1edfng \u0111\u00e3 c\u0169. M\u1ed9t s\u1ed1 l\u0129nh v\u1ef1c khoa h\u1ecdc \u0111\u00e3 c\u1ea9n th\u1eadn xem x\u00e9t c\u1ea7n h\u1ea1 th\u1ea5p gi\u00e1 tr\u1ecb P \u0111\u1ebfn \u0111\u00e2u \u0111\u1ec3 m\u1ed9t ph\u00e1t hi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ee7 cao \u0111\u1ec3 tr\u1edf n\u00ean \u201c\u0111\u00fang\u201d. V\u00ed d\u1ee5, ch\u1ea5p nh\u1eadn m\u1ed9t ng\u01b0\u1ee1ng m\u1ee9c \u00fd ngh\u0129a qui m\u00f4 to\u00e0n b\u1ed9 gen (P<5 x 10^-8) trong b\u1ed9 gen qu\u1ea7n th\u1ec3 l\u00e0m cho c\u00e1c m\u1ed1i li\u00ean h\u1ec7 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n tr\u01b0\u1edbc nay c\u00f3 th\u1ec3 nghi\u00ean c\u1ee9u l\u1ea1i nhi\u1ec1u l\u1ea7n v\u00e0 c\u00e1c m\u1ed1i li\u00ean h\u1ec7 n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n nh\u1ea5t qu\u00e1n khi ki\u1ec3m \u0111\u1ecbnh \u1edf c\u00e1c qu\u1ea7n th\u1ec3 m\u1edbi. Tuy r\u1eb1ng b\u1ed9 gen ng\u01b0\u1eddi r\u1ea5t ph\u1ee9c t\u1ea1p, nh\u01b0ng ng\u01b0\u1eddi ta \u0111\u00e3 bi\u1ebft r\u00f5 ph\u1ea1m vi \u0111\u1ed9 b\u1ed9i (multiplicity) c\u1ee7a vi\u1ec7c ki\u1ec3m \u0111\u1ecbnh m\u1ee9c \u00fd ngh\u0129a \u0111ang quan t\u00e2m, c\u00e1c ph\u00e2n t\u00edch th\u00ec c\u00f3 h\u1ec7 th\u1ed1ng v\u00e0 t\u01b0\u1eddng minh, v\u00e0 nh\u01b0 v\u1eady c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u P<5 x 10^-8 m\u1ed9t c\u00e1ch thuy\u1ebft ph\u1ee5c.
\nTuy nhi\u00ean, \u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c l\u0129nh v\u1ef1c nghi\u00ean c\u1ee9u y sinh h\u1ecdc, ng\u01b0\u1eddi ta kh\u00f4ng bi\u1ebft r\u00f5 \u0111\u1ed9 b\u1ed9i li\u00ean quan v\u00e0 c\u00e1c ph\u00e2n t\u00edch l\u1ea1i kh\u00f4ng h\u1ec7 th\u1ed1ng v\u00e0 kh\u00f4ng t\u01b0\u1eddng minh. \u0110\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u ph\u00e1t hi\u1ec7n m\u00e0 kh\u00f4ng c\u00f3 qui tr\u00ecnh nghi\u00ean c\u1ee9u v\u00e0 k\u1ebf ho\u1ea1ch ph\u00e2n t\u00edch \u0111\u0103ng k\u00ed t\u1eeb tr\u01b0\u1edbc, vi\u1ec7c ti\u1ebfn h\u00e0nh bao nhi\u00eau ph\u00e2n t\u00edch v\u00e0 t\u00ecm ra c\u00e1c con \u0111\u01b0\u1eddng ph\u00e2n t\u00edch n\u00e0o kh\u00e1c l\u00e0 kh\u00f4ng r\u00f5 r\u00e0ng. Gi\u1ea5u gi\u1ebfm \u0111\u1ed9 b\u1ed9i, ph\u00e1t hi\u1ec7n kh\u00f4ng mang t\u00ednh h\u1ec7 th\u1ed1ng v\u00e0 b\u00e1o c\u00e1o ch\u1ecdn l\u1ecdc th\u1eadm ch\u00ed c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea3 nghi\u00ean c\u1ee9u th\u1ef1c nghi\u1ec7m v\u00e0 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean h\u00f3a. M\u1eb7c d\u00f9 vi\u1ec7c \u0111\u0103ng t\u1ea3i qui tr\u00ecnh nghi\u00ean c\u1ee9u v\u00e0 k\u1ebf ho\u1ea1ch ph\u00e2n t\u00edch th\u1ed1ng k\u00ea c\u00f3 t\u1eeb tr\u01b0\u1edbc l\u00ean c\u01a1 s\u1edf d\u1eef li\u1ec7u c\u00f4ng khai \u0111ang tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn h\u01a1n, song th\u1ef1c t\u1ebf v\u1eabn c\u00f3 s\u1ef1 t\u1ef1 do nh\u1ea5t \u0111\u1ecbnh v\u1ec1 c\u00e1ch th\u1ee9c ph\u00e2n t\u00edch d\u1eef li\u1ec7u v\u00e0 k\u1ebft qu\u1ea3 c\u0169ng nh\u01b0 l\u1ef1a ch\u1ecdn tr\u00ecnh b\u00e0y \u0111\u00edch x\u00e1c th\u00f4ng tin n\u00e0o. Ngo\u00e0i ra, nhi\u1ec1u nghi\u00ean c\u1ee9u trong l\u00e2m s\u00e0ng hi\u1ec7n nay t\u1eadp trung v\u00e0o c\u00e1c l\u1ee3i \u00edch ho\u1eb7c nguy c\u01a1 nh\u1ecf h\u01a1n; do \u0111\u00f3, nguy c\u01a1 g\u1eb7p nhi\u1ec1u sai s\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 c\u0169ng t\u0103ng l\u00ean.
\nD\u1ecbch chuy\u1ec3n ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb P t\u1eeb 0,05 xu\u1ed1ng 0,005 s\u1ebd thay \u0111\u1ed5i kho\u1ea3ng 1\/3 s\u1ed1 k\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea t\u1eeb y v\u0103n trong qu\u00e1 kh\u1ee9 th\u00e0nh ch\u1ec9 c\u00f3 t\u00ednh \u201cg\u1ee3i \u00fd\u201d [1]. S\u1ef1 d\u1ecbch chuy\u1ec3n n\u00e0y l\u00e0 c\u1ea7n thi\u1ebft cho nh\u1eefng ai tin (c\u00f3 th\u1ec3 n\u00f3i l\u00e0 m\u1ed9t c\u00e1ch qua loa) v\u00e0o s\u1ef1 tr\u1eafng \u0111en, c\u00f3 hay kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. \u0110\u1ed1i v\u1edbi tuy\u1ec7t \u0111\u1ea1i \u0111a s\u1ed1 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t trong qu\u00e1 kh\u1ee9, s\u1ef1 t\u00e1i ph\u00e2n lo\u1ea1i n\u00e0y s\u1ebd r\u1ea5t \u0111\u01b0\u1ee3c ch\u00e0o \u0111\u00f3n. V\u00ed d\u1ee5, c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u1ee7a Mendel cho th\u1ea5y ch\u1ec9 c\u00f3 m\u1ed9t s\u1ed1 \u00edt kh\u1eb3ng \u0111\u1ecbnh trong qu\u00e1 kh\u1ee9 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t c\u00f3 P<0,05 th\u1ec3 hi\u1ec7n m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3 [5]. Nh\u01b0 v\u1eady, vi\u1ec7c gi\u1ea3m m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea c\u00f3 th\u1ec3 lo\u1ea1i b\u1ecf h\u1ea7u h\u1ebft nh\u1eefng \u1ed3n \u00e0o xung quanh m\u00e0 g\u1ea7n nh\u01b0 kh\u00f4ng l\u00e0m m\u1ea5t c\u00e1c th\u00f4ng tin quan tr\u1ecdng. \u0110\u1ed1i v\u1edbi th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, t\u1ec9 l\u1ec7 \u1ea3nh h\u01b0\u1edfng th\u1ef1c s\u1ef1 l\u00e0 \u0111\u00fang m\u00e0 gi\u00e1 tr\u1ecb P trong kho\u1ea3ng 0,005 \u0111\u1ebfn 0,05 s\u1ebd cao h\u01a1n, c\u00f3 th\u1ec3 s\u1ebd l\u00e0 ph\u1ea7n l\u1edbn c\u00e1c k\u1ebft qu\u1ea3 \u1edf m\u1ed9t s\u1ed1 l\u0129nh v\u1ef1c. Tuy nhi\u00ean, h\u1ea7u h\u1ebft c\u00e1c ph\u00e1t hi\u1ec7n \u0111\u1ec1u kh\u00f4ng th\u1ec3 hi\u1ec7n t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ee7 l\u1edbn \u0111\u1ec3 c\u00f3 ch\u1ec9 s\u1ed1 \u0111\u1ea7u ra quan tr\u1ecdng \u0111\u1ee7 \u0111\u1ebfn m\u1ee9c \u0111\u00e1ng ph\u1ea3i h\u00e0nh \u0111\u1ed9ng th\u00eam. Nh\u01b0 v\u1eady, vi\u1ec7c l\u00e0m gi\u1ea3m ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb P c\u00f3 th\u1ec3 mang l\u1ea1i nhi\u1ec1u \u00edch l\u1ee3i h\u01a1n l\u00e0 t\u00e1c h\u1ea1i, m\u1eb7c d\u00f9 \u0111\u00f4i khi c\u0169ng lo\u1ea1i b\u1edbt \u0111i m\u1ed9t t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb th\u1ef1c s\u1ef1 t\u1ed3n t\u1ea1i v\u00e0 c\u00f3 l\u1ee3i kh\u1ecfi v\u00f9ng \u00fd ngh\u0129a mong mu\u1ed1n. D\u00f9 sao, c\u0169ng kh\u00f4ng th\u1ec3 ph\u00f3ng \u0111\u1ea1i s\u1ef1 c\u1ea7n thi\u1ebft vi\u1ec7c t\u1eadp trung c\u00f9ng l\u00fac v\u00e0o m\u1ee9c \u0111\u1ed9 c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb v\u00e0 s\u1ef1 kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng n\u00e0y.<\/p>\n
H\u1ea1 th\u1ea5p ng\u01b0\u1ee1ng m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea ch\u1ec9 l\u00e0 bi\u1ec7n ph\u00e1p t\u00ecnh th\u1ebf. N\u00f3 s\u1ebd gi\u1ed1ng nh\u01b0 m\u1ed9t con \u0111\u1eadp gi\u00fap c\u00f3 th\u00eam th\u1eddi gian v\u00e0 \u0111\u1ec1 ph\u00f2ng b\u1ecb nh\u1ea5n ch\u00ecm trong d\u00f2ng n\u01b0\u1edbc l\u0169 \u00fd ngh\u0129a th\u1ed1ng k\u00ea, trong khi x\u00e2y d\u1ef1ng c\u00e1c gi\u1ea3i ph\u00e1p t\u1ed1t v\u00e0 b\u1ec1n v\u1eefng h\u01a1n [6]. C\u00e1c gi\u1ea3i ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 bao g\u1ed3m vi\u1ec7c b\u1ecf \u0111i to\u00e0n b\u1ed9 c\u00e1c m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea hay gi\u00e1 tr\u1ecb P. N\u1ebfu v\u1eabn c\u00f2n ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng m\u1ed9t ng\u01b0\u1ee1ng n\u00e0o \u0111\u00f3 th\u00ec r\u1ea5t c\u00f3 th\u1ec3 nh\u1eefng ng\u01b0\u1ee1ng th\u1eadm ch\u00ed c\u00f2n th\u1ea5p h\u01a1n m\u1edbi \u0111\u00e1ng d\u00f9ng cho h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t. C\u00e1c t\u1ed5ng quan to\u00e0n di\u1ec7n (umbrella reviews) \u0111\u00e1nh gi\u00e1 nhi\u1ec1u t\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u1ec1 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t ng\u01b0\u1ee1ng P<10^-6 [5]. Th\u00eam n\u1eefa, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng \u0111i\u1ec3m k\u1ebft th\u00fac (endpoint) g\u00e2y sai l\u1ec7ch (ngh\u0129a l\u00e0 s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb P m\u00e0 \u1edf \u0111\u00f3 h\u1ea7u h\u1ebft c\u00e1c m\u1ed1i li\u00ean h\u1ec7 v\u1edbi gi\u1ea3 thuy\u1ebft kh\u00f4ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 s\u1ebd kh\u00f4ng th\u1ec3 v\u01b0\u1ee3t qua \u0111\u01b0\u1ee3c) c\u0169ng s\u1ebd d\u1eabn t\u1edbi gi\u00e1 tr\u1ecb P r\u1ea5t th\u1ea5p [7]. V\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c d\u1eef li\u1ec7u l\u1edbn, m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea s\u1ebd ng\u00e0y c\u00e0ng mang r\u1ea5t \u00edt \u00fd ngh\u0129a v\u00ec c\u00e1c gi\u00e1 tr\u1ecb P c\u1ef1c k\u00ec th\u1ea5p th\u01b0\u1eddng thu \u0111\u01b0\u1ee3c khi c\u00e1c t\u00edn hi\u1ec7u (d\u00f9 \u0111\u00fang) c\u00f3 \u00edch l\u1ee3i l\u00e0 qu\u00e1 nh\u1ecf.<\/p>\n
Ch\u1ea5p nh\u1eadn ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb P th\u1ea5p h\u01a1n c\u00f3 th\u1ec3 gi\u00fap x\u00e2y d\u1ef1ng m\u1ed9t h\u1ed3 s\u01a1 nghi\u00ean c\u1ee9u c\u1ea3i t\u1ed5 v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u c\u00f3 s\u1ed1 l\u01b0\u1ee3ng \u00edt h\u01a1n, qui m\u00f4 l\u1edbn h\u01a1n, \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng v\u00e0 thi\u1ebft k\u1ebf c\u1ea9n th\u1eadn h\u01a1n v\u1edbi l\u1ef1c nghi\u00ean c\u1ee9u \u0111\u1ee7 l\u1edbn \u0111\u1ec3 v\u01b0\u1ee3t qua c\u00e1c ng\u01b0\u1ee1ng \u0111\u00f2i h\u1ecfi ng\u00e0y c\u00e0ng cao. Tuy nhi\u00ean, c\u00e1c t\u00e1c h\u1ea1i b\u00ean c\u1ea1nh \u0111\u00f3 c\u0169ng s\u1ebd xu\u1ea5t hi\u1ec7n. Sai s\u1ed1 c\u00f3 th\u1ec3 t\u0103ng l\u00ean thay v\u00ec gi\u1ea3m \u0111i n\u1ebfu c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u v\u00e0 c\u00e1c b\u00ean li\u00ean quan (v\u00ed d\u1ee5 nh\u00e0 t\u00e0i tr\u1ee3 nghi\u00ean c\u1ee9u v\u00ec l\u1ee3i nhu\u1eadn) c\u1ed1 t\u00ecm c\u00e1ch \u0111\u1ec3 \u0111\u01b0a ra c\u00e1c k\u1ebft qu\u1ea3 c\u00f3 gi\u00e1 tr\u1ecb P th\u1ea5p h\u01a1n. C\u00e1c \u0111i\u1ec3m k\u1ebft th\u00fac nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn c\u00f3 th\u1ec3 tr\u1edf n\u00ean \u00edt ph\u00f9 h\u1ee3p v\u1edbi l\u00e2m s\u00e0ng h\u01a1n v\u00ec c\u00f3 \u0111\u01b0\u1ee3c c\u00e1c gi\u00e1 tr\u1ecb P th\u1ea5p v\u1edbi c\u00e1c \u0111i\u1ec3m k\u1ebft th\u00fac \u0111\u1ea1i di\u1ec7n th\u00ec d\u1ec5 h\u01a1n l\u00e0 v\u1edbi c\u00e1c ch\u1ec9 s\u1ed1 l\u00e2m s\u00e0ng kh\u00f3 th\u1ef1c hi\u1ec7n. H\u01a1n n\u1eefa, c\u00e1c k\u1ebft qu\u1ea3 v\u01b0\u1ee3t qua ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb P \u0111\u01b0\u1ee3c h\u1ea1 th\u1ea5p c\u00f3 th\u1ec3 b\u1ecb h\u1ea1n ch\u1ebf b\u1edfi s\u1ef1 h\u1ed3i qui nhi\u1ec1u h\u01a1n v\u1ec1 gi\u00e1 tr\u1ecb trung b\u00ecnh v\u00e0 c\u00e1c ph\u00e1t hi\u1ec7n m\u1edbi th\u1eadm ch\u00ed c\u00f3 th\u1ec3 c\u00f2n ph\u00f3ng \u0111\u1ea1i h\u01a1n tr\u01b0\u1edbc \u0111\u1ed9 l\u1edbn c\u1ee7a \u1ea3nh h\u01b0\u1edfng.<\/p>\n
Do ng\u01b0\u1ee1ng P<0,005 l\u00e0 kh\u00f4ng ho\u00e0n h\u1ea3o, c\u0169ng c\u1ea7n t\u00ednh \u0111\u1ebfn c\u00e1c gi\u1ea3i ph\u00e1p kh\u00e1c d\u00f9 kh\u00f3 kh\u0103n h\u01a1n nh\u01b0ng b\u1ec1n v\u1eefng h\u01a1n (Xem B\u1ea3ng). C\u00e1c gi\u1ea3i ph\u00e1p n\u00e0y kh\u00e1c nhau t\u00f9y theo m\u1ee9c \u0111\u1ed9 ch\u1ea5p nh\u1eadn nhanh ch\u00f3ng v\u00e0 d\u1ec5 d\u00e0ng c\u1ee7a ch\u00fang. C\u00e1c gi\u1ea3i ph\u00e1p c\u00f3 th\u1ec3 h\u01b0\u1edbng \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng v\u00e0 bi\u1ec7n gi\u1ea3i c\u00e1c y v\u0103n trong qu\u00e1 kh\u1ee9 t\u00ednh d\u1ed3n \u0111\u1ebfn nay ho\u1eb7c c\u00e1c thi\u1ebft k\u1ebf v\u00e0 tri\u1ec3n khai trong c\u00e1c y v\u0103n m\u1edbi t\u00edch l\u0169y trong t\u01b0\u01a1ng lai. T\u00ecnh h\u00ecnh r\u1ea5t kh\u1ed1c li\u1ec7t \u0111\u1ed1i v\u1edbi y v\u0103n trong qu\u00e1 kh\u1ee9 b\u1edfi l\u1ebd kh\u00f4ng c\u00f3 c\u00e1ch s\u1eeda ch\u1eefa ho\u00e0n h\u1ea3o n\u00e0o sau khi s\u1ef1 vi\u1ec7c \u0111\u00e3 k\u1ebft th\u00fac. V\u1ec1 l\u00e2u d\u00e0i, gi\u1edbi khoa h\u1ecdc s\u1ebd c\u1ea7n \u0111\u01b0\u1ee3c t\u1eadp hu\u1ea5n m\u1ed9t c\u00e1ch ph\u00f9 h\u1ee3p h\u01a1n v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c c\u00f4ng c\u1ee5 suy lu\u1eadn th\u1ed1ng k\u00ea ph\u00f9 h\u1ee3p nh\u1ea5t theo m\u1ee5c \u0111\u00edch v\u00e0 c\u1ea7n h\u01b0\u1edbng t\u1edbi d\u1ef1 ki\u1ebfn gi\u1ea3i quy\u1ebft tr\u01b0\u1edbc thay v\u00ec gi\u1ea3i quy\u1ebft h\u1ed3i c\u1ee9u l\u1ea1i sai s\u1ed1. Tuy nhi\u00ean, \u0111\u00e2y c\u00f3 th\u1ec3 l\u1ea1i ti\u1ebfp t\u1ee5c l\u00e0 c\u00e1c m\u1ee5c ti\u00eau g\u1ea7n nh\u01b0 kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c.<\/p>\n
B\u1ea3ng: \u0110\u1ec1 xu\u1ea5t c\u00e1c gi\u1ea3i ph\u00e1p kh\u00e1c nhau cho vi\u1ec7c ti\u1ebfn h\u00e0nh suy lu\u1eadn th\u1ed1ng k\u00ea tr\u00ean qui m\u00f4 l\u1edbn
\nC\u00e1c d\u1eef li\u1ec7u ng\u00e0y c\u00e0ng tr\u1edf n\u00ean ph\u1ee9c t\u1ea1p. N\u1ebfu v\u1eabn c\u00f2n h\u1ea1n ch\u1ebf v\u1ec1 th\u1eddi gian t\u1eadp hu\u1ea5n m\u1ed9t c\u00e1ch k\u0129 l\u01b0\u1ee1ng cho c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u v\u00e0 s\u1eed d\u1ee5ng nghi\u00ean c\u1ee9u v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u v\u00e0 th\u1ed1ng k\u00ea th\u00ec c\u00e1c th\u1ed1ng k\u00ea y h\u1ecdc k\u00e9m d\u01b0\u1edbi m\u1ee9c trung b\u00ecnh v\u00e0 s\u1ef1 bi\u1ec7n gi\u1ea3i sai l\u1ea7m c\u00f9ng v\u1edbi \u0111\u00f3 v\u1eabn c\u00f2n ti\u1ebfp di\u1ec5n. Tuy v\u1eady, hi v\u1ecdng r\u1eb1ng nhi\u1ec1u l\u0129nh v\u1ef1c s\u1ebd ch\u1ea5p nh\u1eadn c\u00e1c ti\u00eau chu\u1ea9n t\u1ed1t h\u01a1n v\u1ec1 gi\u00e1 tr\u1ecb P, gi\u1ea3m d\u1ea7n s\u1ef1 ph\u1ee5 thu\u1ed9c v\u00e0o gi\u00e1 tr\u1ecb P v\u00e0 t\u0103ng c\u01b0\u1eddng ch\u1ea5p nh\u1eadn c\u00e1c c\u00f4ng c\u1ee5 suy lu\u1eadn h\u1eefu \u00edch kh\u00e1c (nh\u01b0 th\u1ed1ng k\u00ea Bayes) khi c\u00f3 th\u1ec3. S\u1ef1 nhanh ch\u00f3ng v\u00e0 m\u1ee9c \u0111\u1ed9 c\u1ee7a c\u00e1c thay \u0111\u1ed5i n\u00e0y l\u00e0 kh\u00f4ng th\u1ec3 ti\u00ean \u0111o\u00e1n \u0111\u01b0\u1ee3c. S\u1ef1 ch\u1ea5p thu\u1eadn \u00edt \u1ecfi n\u00e0y trong qu\u00e1 kh\u1ee9 c\u00f3 th\u1ec3 g\u00e2y \u00edt nhi\u1ec1u bi quan. Tuy nhi\u00ean, m\u1ed9t kh\u1edfi \u0111\u1ea7u t\u01b0\u01a1i m\u1edbi v\u00e0 t\u0103ng ti\u1ebfn nhanh ch\u00f3ng cho vi\u1ec7c ch\u1ea5p nh\u1eadn nh\u1eefng th\u1ef1c h\u00e0nh t\u1ed1t h\u01a1n l\u00e0 lu\u00f4n lu\u00f4n c\u00f3 th\u1ec3 x\u1ea3y ra. S\u1ef1 khuy\u1ebfn kh\u00edch t\u1eeb c\u00e1c t\u1ea1p ch\u00ed v\u00e0 qu\u0129 h\u1ed7 tr\u1ee3 l\u1edbn c\u0169ng nh\u01b0 nh\u1eefng thay \u0111\u1ed5i c\u0103n b\u1ea3n trong c\u00e1c kh\u00f3a t\u1eadp hu\u1ea5n c\u00f3 th\u1ec3 s\u1ebd c\u1ea7n thi\u1ebft nh\u1eb1m \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1eefng thay \u0111\u1ed5i r\u1ed9ng r\u00e3i v\u00e0 hi\u1ec7u qu\u1ea3.
\n—————————————————————-
\nT\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n
Chavalarias D, Wallach JD, Li AH, Ioannidis JP. Evolution of reporting P values in the biomedical literature, 1990-2015. JAMA. 2016;315(11):1141-1148.
\nIoannidis JP. Why most published research findings are false. PLoS Med. 2005;2(8):e124.
\nWasserstein RL, Lazar NA. The ASA\u2019s statement on P-values: context, process, and purpose. Am Stat. 2016;70(2):129-133.
\nBenjamin DJ, Berger JO, Johnson VE, et al. Redefine statistical significance. Nat Hum Behav. 2018;2:6-10.
\nLi X, Meng X, Timofeeva M, et al. Serum uric acid levels and multiple health outcomes. BMJ. 2017;357:j2376.
\nResnick B. What a nerdy debate about P values shows about science-and how to fix it. https:\/\/www.vox.com\/science-and-health\/2017\/7\/31\/16021654\/p-values-statistical-significance-redefine-0005. Accessed February 1, 2018.
\nPrasad V, Jena AB. Prespecified falsification end points. JAMA. 2013;309(3):241-242.<\/p>\n
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<\/p>\n","protected":false},"excerpt":{"rendered":"
(T\u00e1c gi\u1ea3: TS.BS. John P. A. Ioannidis. Quan \u0111i\u1ec3m y khoa \u0111\u0103ng tr\u00ean JAMA ng\u00e0y 22\/3\/2018) Gi\u00e1 tr\u1ecb P v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m \u0111\u1ecbnh m\u1ee9c \u00fd ngh\u0129a th\u1ed1ng k\u00ea k\u00e8m theo n\u00f3 \u0111ang t\u1ea1o ra nh\u1eefng th\u00e1ch th\u1ee9c trong y sinh h\u1ecdc v\u00e0 nhi\u1ec1u chuy\u00ean ng\u00e0nh kh\u00e1c. Tuy\u1ec7t \u0111\u1ea1i \u0111a s\u1ed1 (96%) c\u00e1c b\u00e0i […]\n","protected":false},"author":1,"featured_media":4108,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4107","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4107","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=4107"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4107\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/4108"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=4107"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=4107"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=4107"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}