15 Questions
What was Bernie Fox's field of expertise?
Epidemiology
True or false: Bernie Fox argued that the differences in survival in the Spiegelet et al. (1989) study were due to chance.
True
According to the text, what is the main issue with using randomized clinical trials to evaluate the causal effects of psychosocial interventions on cancer outcomes?
They are not able to distinguish between prediction and causation.
What did Bernie Fox critique in the 1989 study by Spiegelet al.?
The small group sizes in the study
What did Bernie Fox critique in the 1989 study by Spiegelet et al.?
The study's methodology
True or false: Randomized clinical trials (RCTs) are capable of distinguishing causal effects from predictions.
False
What is the goal of an integrated RCT design?
To distinguish between prediction and causation
What type of design does Fox suggest to take into account the psychogenicity of a given intervention?
Integrated RCT
True or false: Fox proposed that an integrated RCT design should take into account psychogenicity, mediating mechanisms, and individual differences.
True
What did Fox argue about the 1989 study by Spiegelet et al.?
That the difference in survival was due to chance
True or false: Fox suggested that biomedical studies are more likely to be able to determine the effect of an intervention correctly.
True
What is the main difference between biomedical studies of drugs and biopsychosocial studies?
Biomedical studies are more likely to assign causality correctly.
What is an impossible Catch-22 when it comes to proving unmeasured risk factors?
Proving that unmeasured risk factors contributed to significant group differences
What type of studies are more likely to assign causality correctly?
Biomedical studies
True or false: Fox argued that it was impossible to prove that unmeasured risk factors contributed to significant group differences in Spiegel et al. (1989).
True
Study Notes
- Bernard Fox was an epidemiologist and biostatistician who made seminal contributions to psycho-oncology, and whose scholarship in biopsychosocial cancer epidemiology was instrumental in establishing the field.
- Fox applied his breadth of scholarship in biopsychosocial cancer epidemiology to address the question of whether and to what extent stress and other psychosocial factors may contribute to cancer risk.
- Fox critiqued the 1989 study by Spiegelet al. on survival time of patients with metastatic breast cancer following a psychosocial intervention, arguing that the study was inadequate and that more research was needed to evaluate the causal effects of psychosocial interventions on cancer outcomes.
- This essay represents an attempt to take Fox’s line of thought to the next logical level of rethinking research on psychosocial interventions in biopsychosocial oncology. Following an analysis of the inadequacy of randomized clinical trials (RCT) to evaluate the causal effects of psychosocial interventions on cancer outcomes and distinguish these from mere prediction, an integrated RCT design is suggested to take into account thepsychogenicityofa given intervention, potential mediating mechanisms, and individual differences that could help illuminate hypothesized causal processes linking an experimental intervention and cancer outcomes.
- Bernie Fox critiqued a study that found that participants assigned to a support group survived longer than those in a control group.
- Fox argued that the difference in survival was due to chance, not to the intervention.
- He also predicted that any larger replication trial would fail to find a similar intervention effect.
- In contrast, biomedical studies of drugs are able to control for many variables and are more likely to assign causality correctly.
- Therefore, biopsychosocial studies are less likely to be able to determine the effect of an intervention correctly.
- Fox's 1998 article argued that the small group sizes in the Spiegelet al. (1989) study increased the possibility that confounding factors were, by chance, loaded into one or the other of the randomized groups.
- This argument is no less potent (as Spiegelet al. (1998) contended) because he could not nominate or prove the existence of such factors.
- It is an impossible Catch-22, however, to prove that, in someone else’s study, unmeasured risk factors contributed to significant group differences, precisely because these factors were not measured!
- Many of the same factors would also contribute to cancer progression and outcomes, and be germane to a consideration of factors that may have contributed to greater risk for progression for the control group in Spiegelet al. (1989).
- Interactions with individual differences cannot be controlled as in biomedical clinical trials, because not only are they part of the effect on outcome, but they are intrinsic to this effect.
- A biomedical RCT is a study designed to test simple cause and effect relationships among biomedical variables.
- When a psychosocial intervention is translated into a biopsychosocial model, the study becomes a "retro-prospective" B-H design, with multiple independent, mediating, and dependent variables.
- Predicting an event from a set of variables is not the same as knowing the cause of the event. A causal model works if it is able to specify the times, conditions, and/or individuals under which the cause-effect linkages are strong.
- The predominant use of certain statistical methods, and the inappropriate application of the biomedical RCT design to studies of psycho-social interventions, bias studies in terms of only being able to investigate relationships in terms of predictive rather than causal relationships.
Test your knowledge on Bernie Fox's contributions to biopsychosocial oncology, including his critique of psychosocial interventions in cancer research and the differences between biomedical RCTs and biopsychosocial studies.
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