Making the world a simpler place: the modeller’s temptation to seek alternative trial results

Summary box Murray et al suggest, via sophisticated mathematical modelling, that a radio intervention saved thousands of lives in Burkina Faso because it increased care-seeking for childhood illnesses, and that it could save tens of thousands more if scaled up across sub-Saharan Africa.1 2 In this commentary, we examine Murray et al ’s methods, remind readers that the Burkina Faso trial found no effect on child mortality and argue that privileging modelled over actual empirical data is both questionable and unnecessary. We have five concerns about the methods used in Murray et al . First, the authors ignore empirically recorded mortality data from the trial’s control arm, and instead choose to use a modelled estimate of higher mortality relative to the intervention arm. Second, the models assume that all children seeking treatment for pneumonia received appropriate care and oral antibiotics. We know this is often not the case and is even less likely when a health system is strained by sudden increases in care-seeking.3 Third, there is no discussion of the significant increase in consultations for ‘other diagnoses’ in the trial’s control arm. This indicates that the …