An introduction to biostatistics for biomedical researchers
A new compound is given to 3 mice, with 3 controls. At day 21 the treated tumors are smaller, on average by a third. The t-test says p = 0.03.
Your PI says: write it up.
How much can this result tell us?
The p-value alone cannot settle this. Ask about the design, independent units, effect and interval, analysis choices, and supporting evidence.
A scientific question guides each decision. The result informs the next question.
| Stage | Decision | What you carry forward |
|---|---|---|
| 01 Question | What do we want to learn? | Population, outcome and target quantity |
| 02 Design | What evidence could answer it? | Units, allocation, n and analysis plan |
| 03 Prepare & explore | What did we actually measure? | Traceable data and diagnostic plots |
| 04 Analyze | What do the data support? | Effect estimates and uncertainty |
| 05 Evaluate | How well does the conclusion hold up? | Checks, limitations and independent evidence |
| 06 Communicate & iterate | What should others know or study next? | A transparent report and a new question |
What do we want to learn?
What patterns and variation are in the data?
Tumor-volume distributions, plots, group summaries.
How large is an effect, and how uncertain is it?
Differences, rates, regression estimates and intervals.
What would change if we gave the treatment?
Randomized experiments and causal assumptions.
What will happen to a new patient or sample?
Risk models, statistical learning and validation on new data.
Frameworks: frequentist and Bayesian inference. Tool families: regression, survival analysis, longitudinal and multilevel models, high-dimensional methods.
Would giving the compound reduce tumor volume?
Which new mouse will have a large tumor at day 21?
Does the compound reduce mean tumor volume at day 21?
Mice represented by this tumor model and protocol. Compare treatment with a concurrent control.
Tumor volume in mm³ at day 21. Target quantity: mean treated minus mean control volume.
Assign treatment to individual mice. Randomize across batches and blind outcome measurement.
For this example, a 150 mm³ reduction matters. Assume between-mouse SD 120 mm³. We will choose n for a proposed study.
Pre-specify exclusions and how deaths or missing day-21 measurements will be handled. A missing outcome can change the question you actually answer.
What evidence could answer the question?
set.seed(2026)
sample(rep(c("Treated","Control"), each = 10))
Example: 20 individually assigned mice, 10 per arm. Save the seed, list and assignment process; use blocks when needed.
| Drug | No drug | |
|---|---|---|
| Men | 81 / 87 (93%) | 234 / 270 (87%) |
| Women | 192 / 263 (73%) | 55 / 80 (69%) |
| Everyone | 273 / 350 (78%) | 289 / 350 (83%) |
Illustrative recovery rates: the treated group has higher recovery within each sex, but lower recovery overall because the group proportions differ. These associations alone do not establish a treatment effect.
Derived cut-off: c = −1.645. Reject if Z < c; otherwise do not reject.
Δ = μtreated − μcontrol.
For this power calculation: H₀: Δ = 0; Ha: Δ = −150 mm³.
350 − 500 = −150: treated tumors are smaller on average.
Δ = μtreated − μcontrol.
H₀: Δ = 0; Ha: Δ = −150 mm³ for planning.
n <- 3; df <- 2*n - 2 pt(qt(0.05, df), df, ncp = -150/(120*sqrt(2/n))) # power = 0.356
power.t.test(), power.prop.test(), package pwr.What did we actually measure?
Three hypothetical records from the day-21 tumor-volume study.
| Record | What the audit finds | What to do |
|---|---|---|
| M04: 4,800 mm³ | The original measurement log says 480 mm³. | Correct the verified transcription error. Preserve the raw entry and log the correction. |
| M09: no day-21 value | The mouse died on day 18. | Record the death and its timing. A day-21 volume after death is undefined; do not enter zero or silently drop the mouse. |
| M12: 1,100 mm³ | The source agrees; measurement checks pass and the mouse meets eligibility rules. | Retain the valid observation. Assess its influence and report sensitivity results alongside the primary analysis. |
A pattern suggests a question or check; it does not choose the analysis for us.
| What the plot shows | What to ask | Next step |
|---|---|---|
| Two clusters | Do batch, sex or measurement time explain the pattern? | Label known factors and investigate. Shape alone does not establish responder groups. |
| A verified influential observation | How much does the estimate depend on this observation? | Report justified sensitivity analyses alongside the primary estimate and its uncertainty. |
| A skewed distribution | Is the target a mean difference in mm³ or a proportional effect? | Check model assumptions. A log-scale comparison changes the effect being estimated. |
| Repeated or nested observations | Which measurements share a mouse, cage or site? | Keep IDs and links visible; account for dependence in the analysis. |
Handoff to analysis: a traceable dataset, a defined effect, an analysis plan and documented exploratory questions.
Hypothetical measurements · Each dot is one observation; A, B and C identify independent biological samples.
Repeat readings are close; different mice vary more.
3 mice · 6 readings
Triplicates agree within a sample; samples differ.
3 donors · 9 reactions
Repeated readings vary within each patient.
3 patients · 9 readings
Fields vary within a specimen; clustering can add spread.
3 specimens · 9 fields
Each donor reads higher on day 2. Check for run effects.
3 donors · 6 aliquots
What do the data support, and how uncertain are we?
Random allocation supports a treatment comparison. Generalizing to other strains, laboratories or patients needs additional evidence.
Δ = μtreated − μcontrol (mean tumor volume, mm³).
H₀: Δ = 0 versus Ha: Δ ≠ 0 (two-sided).
“P-values do not measure the probability that the studied hypothesis is true.” American Statistical Association, 2016
Start with what is measured, who is independent, and which comparison answers the question.
| Biomedical question | Design / outcome | Method and useful estimate |
|---|---|---|
| Do two sleep drugs differ in the same patients? | Paired continuous measurements | Paired t-test Mean within-person difference |
| Does tooth development differ across vitamin C doses? | Three independent groups; continuous outcome | ANOVA + planned contrasts Specified difference in means |
| Does treatment improve infection clearance? | Independent groups; binary outcome | Fisher’s exact / χ² test Difference in response probabilities |
| Does treatment lower blood pressure after accounting for baseline? | Continuous outcome + baseline measurement | Regression / ANCOVA Adjusted mean difference |
| Does maintenance therapy prolong remission? | Time to relapse; some follow-up is censored | Kaplan–Meier + log-rank Remission curve and comparison |
| How does the relapse rate compare during follow-up? | Time-to-event regression | Cox regression Hazard ratio, with assumptions |
Do two sleep drugs produce different mean increases in sleep? Historical data: 10 patients received both.
The independent units are 10 patients. Pairing retains the link between each person’s measurements.
d = extra sleep on drug 2 − drug 1.
H₀: μd = 0 vs. Ha: μd ≠ 0.
+1.58 hours
95% CI: +0.70 to +2.46 hours
Paired t-test: t(9) = 4.06; p = 0.0028.
Drug 2 is associated with a larger mean increase in sleep in these paired data.
Independent patients; approximately normal differences for this small sample. Consider order and carryover in a crossover design.
Vitamin C and tooth development: 30 guinea pigs, 3 doses, one delivery method (ascorbic acid).
One animal = one observation. Use the animal-level outcome, not each cell as an independent replicate.
H₀: μ0.5 = μ1 = μ2
Ha: at least one mean differs.
F(2, 27) = 67.07; p = 3.36 × 10⁻¹¹.
ANOVA alone does not identify which doses differ or how much.
Δ = μ2 − μ0.5
H₀: Δ = 0 vs. Ha: Δ ≠ 0.
+18.16 units
95% CI: +14.94 to +21.38 units.
Illustrative unadjusted contrast. Prespecify comparisons; correct for multiplicity across a family of tests.
Assumptions: independent animals; approximately normal errors with common variance. Check residuals and unequal spread.
Illustrative trial: does a new antimicrobial increase culture clearance at day 14?
Design: 24 participants randomized, 12 per group; one day-14 result each.
H₀: πT = πC
Ha: πT ≠ πC (two-sided).
π = probability of culture clearance.
Estimated increase: 50 percentage points
95% CI: 12.2 to 73.4 points.
Fisher’s exact p = 0.027.
Under H₀, expected clearances are only 4 per group. For this small sample, plan to use Fisher’s exact test; the chi-square approximation may be unreliable.
Method choice: χ² uses a large-sample approximation; Fisher conditions on the margins. Both require independent participants. Paired binary outcomes need a paired method, such as McNemar’s test.
Illustrative trial: does treatment lower week-8 blood pressure, accounting for baseline?
Design: 40 participants randomized, 20 per group. Baseline BP is measured before treatment.
ANCOVA = linear regression
Week-8 BP ~ treatment + baseline BP.
H₀: βT = 0 versus Ha: βT ≠ 0.
βT = adjusted treatment − control difference in mean BP.
Adjusted difference: -7.1 mmHg
95% CI: -10.7 to -3.5.
Two-sided p < 0.001.
At the same baseline BP, the fitted treatment mean is 7.1 mmHg lower. Baseline adjustment can improve precision.
Plan and check: prespecify baseline covariates; assess linearity, common slopes, residual variation and independence. A baseline association is not itself a causal effect.
Acute myeloid leukemia (AML), 23 randomized patients: maintenance = additional chemotherapy to prolong remission.
Drops occur at observed relapse times. A tick marks follow-up ending without an observed relapse.
H₀: SM(t) = SN(t) for all t.
Hₐ: the remission curves differ.
χ²(1) = 3.40; p = 0.065
Suggestive separation, with substantial uncertainty. At α = 0.05, we do not reject H₀.
Censoring means “not observed after this time,” not “never relapses.”
Same 23 AML patients: maintenance chemotherapy (to prolong remission) vs. no maintenance chemotherapy.
Hazard: instantaneous relapse rate among those still in remission.
hM(t) = hN(t) × exp(β)
H₀: β = 0 (HR = 1).
Hₐ: β ≠ 0 (HR ≠ 1).
Estimate: 60% lower relapse hazard with maintenance, assuming a constant hazard ratio.
Uncertainty: the interval includes HR = 1. The data remain compatible with no difference.
Two-sided Wald p = 0.074.
Group-only model; Efron handling of tied event times.
For each variant j: H0j: βj = 0 versus Haj: βj ≠ 0 (two-sided).
βj: adjusted association with systolic blood pressure (SBP), in mmHg per additional effect allele.
Hover or tap to inspect. With plot focused, ← / → select adjacent displayed variants; ↑ / ↓ jump 100. Last details stay visible.
Full SBP file, including known regions:
Bonferroni: reject H0j if
pj < 0.05 / m ≈ –.
With valid null p-values, P(any false rejection) ≤ 5%, even with dependence.
Why dependent? Linkage disequilibrium (LD) correlates nearby variants and their tests. Many significant variants may mark one locus.
Common GWAS cutoff: 5 × 10⁻⁸.
This differs from 0.05 / m for this file.
How well does the conclusion hold up?
Check the calculation, analysis choices and sensitivity to which subjects were sampled.
| Check | What to do | What it tells you |
|---|---|---|
| Computational reproducibility | Run the recorded code on the same data and recover the reported results. | Someone can reproduce the calculation. |
| Assumptions and stability | Compare defensible choices for missing data, outliers and covariates; check model and design. | How sensitive the conclusion is to reasonable choices. |
| Random-split sensitivity | If data are large enough, randomly split independent subjects and repeat the same analysis in each subset. | Compare effect sizes and CIs across splits. Each subset must retain useful precision. |
| Independent evidence | Test the planned claim in new subjects or settings. For prediction, assess untouched data. | Whether the conclusion extends to the relevant new evidence. |
Reserve a confirmation holdout before outcome-driven selection or tuning. Stable results alone do not establish causality.
Stage 1 · Preliminary experiment (hypothetical): 20 outcome/timepoint tests in treated and control mice → day-21 tumor volume has the smallest p = 0.01 and is chosen for follow-up.
What should others know, and what should we study next?
Reconstruct the study life cycle before interpreting the result.
Before pooling data, ask what differs—and which population the result should inform.
| Consideration | What to check or plan |
|---|---|
| Site effects | Labs or hospitals differ in equipment, staff and participants. Randomize within sites when possible; record site and examine differences. |
| Protocol effects | Timing, sample handling, assay version and dose can change outcomes or measurements. Standardize procedures, record deviations and balance groups across batches. |
| Data harmonization | Align definitions, units, coding and measurement times before pooling. Keep original values and mappings; preserve meaningful biological differences. |
| Mixed-effects models | Combine fixed effects (e.g., treatment) with random effects (e.g., site-specific baseline levels) to model clustering. Add subject effects for repeated measurements when appropriate. |
| Population representation | Define the target population. Check coverage of age, sex, ancestry and disease severity—or strain and sex in mice. Identify gaps and assess generalization. |
Question. Define what you want to learn and the effect that matters.
Design. Plan independent units, allocation, measurement and n before collecting data.
Prepare & explore. Keep data traceable, plot observations and document choices.
Analyze. Estimate the effect and uncertainty with methods suited to the design.
Evaluate. Check assumptions and sensitivity, then seek relevant independent evidence.
Communicate & iterate. Report the evidence and limitations. Turn unresolved questions into the next study.
What decision in your own study
needs attention before the next experiment?
Questions & discussion
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Optional discussion: preliminary data and confirmation, optional stopping, power, method selection and further examples.
“Add three more mice if p > 0.05; stop if p < 0.05” gives repeated chances to cross the threshold under the null.
Why fix the target before examining fresh outcomes?
P-hacking: choose analyses or reported results because their p-values are favorable, without accounting for the search.
Double dipping: use data to construct a feature or group, then assess it using the same information as if construction and assessment were independent.
Selective inference: tests and CIs account for how the outcome or model was selected.
Return to the pilot: day-21 tumor volume had the smallest p = 0.01 among 20 outcome/timepoint tests.
Simpler familywise safeguard: for these 20 valid tests, Bonferroni gives 20 × 0.01 = 0.20. This is not a conditional selective p-value or a correction for the gene score.
The answer depends on how the observations influenced the question and analysis.
| Route | What to do | What to watch |
|---|---|---|
| New experiment | Use the pilot to plan; test the chosen question in new independent units. | Report stages separately. Pooling a selected pilot with new data needs justification. |
| Untouched holdout | Reserve whole animals, donors or participants before selection or tuning. | Keep outcomes untouched. Splitting after inspection does not undo selection. |
| Inference that allows reuse | Match the method to the selection rule or planned interim adaptation. | Tests and CIs need appropriate adjustment. Preregistration cannot erase prior selection. |
| All data already explored | Describe the search and findings; plan independent confirmation. | Keep claims exploratory when suitable adjusted inference is unavailable. |
Many reporting requirements begin with decisions made before data collection.
Scott et al. (2008) retested eight compounds previously reported to help SOD1 ALS mice, using improved study designs. They found no survival benefit at the previously reported doses and routes, including for riluzole. This result concerns those regimens in that mouse model.
Sex, litter, transgene copy number and unrelated deaths can distort survival comparisons. Design and model limitations can create misleading efficacy signals. Better design makes the evidence more informative.
Standardized effect d = 150 / 120 = 1.25, a large standardized difference; biological importance depends on context.
Mice per group?
About 9 per group. Even for an effect this large, n = 3 gives only about a one-in-three chance of seeing it.
power.t.test(delta = 150, sd = 120, power = 0.8, alternative = "one.sided") gives n ≈ 8.68; round up to 9 per group.| Outcome | Two independent groups | Two paired or matched | Three or more independent groups | Relationship with a continuous predictor | Adjusting for covariates or repeated measures |
|---|---|---|---|---|---|
| Continuous; target: mean | t-test (Welch) | Paired t-test | ANOVA or Welch ANOVA; planned contrasts | Pearson correlation, linear regression | ANCOVA, linear mixed model |
| Ordinal or skewed; target matters | Mann–Whitney | Signed-rank* or sign test | Kruskal–Wallis | Spearman correlation | Ordinal, rank-based or robust models; transforms change the scale |
| Binary, yes or no | Chi-square, Fisher exact | McNemar | Chi-square | Logistic regression | Logistic regression, GEE |
| Counts | Poisson or negative-binomial regression; rates need exposure offsets; repeated counts need models for clustering | ||||
| Time to event, with censoring | Log-rank test, Kaplan–Meier | Matched/stratified survival analysis | Log-rank | Cox regression | Cox; frailty or cluster methods |
One diagnostic test per person. Assume prevalence 0.4%, sensitivity 80% and specificity 90%.
Among people with a positive test, what fraction have the condition?
Each test addresses one hypothesis and may involve many subjects.
| Input | Assumed value |
|---|---|
| Fraction with a real effect | 10% (100 tests) |
| Fraction with no effect | 90% (900 tests) |
| Power for each real effect | 20% |
| False-positive rate for each true null | 5% |
| Unadjusted significance rule | p < 0.05 |
Among significant results, what fraction correspond to real effects?
Expected: 20 true and 45 false discoveries.
20 / (20 + 45) ≈ 31% under this model.