Inaccurate conclusions due to absence of evidence fallacy on Adiamah et al

  • Igor Eckert
    Correspondence
    Sarmento Leite Street, 245, Centro Historico, Porto Alegre, Rio Grande do Sul, Brazil, 90050-170.
    Affiliations
    Registered Dietitian, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
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Published:November 25, 2021DOI:https://doi.org/10.1016/j.clnu.2021.11.021
      In a long-term survival analysis [
      • Adiamah A.
      • Rollins K.E.
      • Kapeleris A.
      • Welch T.N.
      • Iftikhar S.Y.
      • Allison S.P.
      • et al.
      Postoperative arginine-enriched immune modulating nutrition: long-term survival results from a randomised clinical trial in patients with oesophagogastric and pancreaticobiliary cancer.
      ], Adiamah and colleagues conclude that early postoperative enteral feeding with arginine-enriched immunomodulating nutrition (IMN) confers no additional benefit compared with a control formula. This conclusion of absence of effect assumes the study provides evidence that the treatment confers no benefit. In this letter, I argue that the correct interpretation of these results would lead to different conclusions and potential real-life implications.

      Keywords

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      References

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        Clin Nutr. 2021; 40: 5482-5485
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      Linked Article

      • Response to Igor Eckert: Sometimes, the absence of evidence is evidence of its absence
        Clinical Nutrition
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          “The absence of evidence is not evidence of absence”, is an aphorism attributed to Carl Sagan [1], which is invoked when claims of the existence of God are encountered. Nonetheless, it is a succinct and elegant statement, which in this instance is simultaneously beautiful and wrong. At first glance, the lack of evidence is not evidence of absence, would suggest that for every treatment: medical, nutritional, or alternative therapy unless science has exhausted every mechanistic process available we cannot state it does not work even after randomised, double-blind studies, or as is the case here, multiple systematic reviews, none of which have found survival benefit.
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