Confounding Variable Effects in Medical Studies

In this paper we will focus on examples of the effects of confounding variables in

medical experiments on the health effects of drugs. In general, a confounding variable is

an effect that influences the outcome but is not directly accounted for in the study. When

the confounding variable is also highly correlated with independent variables in the

study, the conclusions of the study become less reliable, as part or all of the effect may be

coming from the confounding variable. We can give examples in medical research (and

patient studies) where the confounding variable can enhance the perceived effects of

independent variables, or lessen it, leading to incorrect conclusions on causes.

The standard way in which medical studies are conducted is a randomized double-

blind study. However, in certain situations ethical considerations may prevent researchers

in designing an unbiased study. For example, consider research on the effects of

antidepressants taken by pregnant mothers in relation to congenital birth defects in their

offspring. An observational study can be designed where a group of pregnant women

who take antidepressants and a different group who are not taking antidepressants are

followed. Comparison of the incidence of birth defects in children born to these two

groups reveals that the antidepressant group has higher rate of birth defects. Statistical

significance tests on group difference between the average rates of birth defects are

conducted and a conclusion is reached that antidepressants are causally related to birth

defects in children.

A serious flaw in such a study can come from confounding variables such as:

higher likelihood of smoking and alcohol use by antidepressant group, higher average age

of the antidepressant group, higher likelihood of illicit drug use and dependency on other
drugs in the antidepressant group. It is known that smoking, consumption of alcohol, drug

use, and advanced age are all positively correlated with increase in birth defects.

Therefore, if there is a correlation between women who engage in these activities and

their use of antidepressants, the original conclusions of the study are misleading: the

effects of antidepressants on birth defects may actually be much less, or even non-

existent. Another example of a confounding variable in this case may be genetic factors

that lead to birth defects, if it happens that the antidepressant group has a higher

incidence of such genetic factors (even when other confounding variables are absent).

Other similar instances where the presence of confounding variables leads to

incorrect conclusions (or significantly decreases the reliability of the study) is when a

medication or a medical procedure designed for preventative purposes is deemed very

effective, whereas in reality a highly correlated behavioral influence played an important

role. For example, an observational study on stroke incidence in people who take low

dosage of aspirin for preventing blood clotting may miss the fact that such people also

engage in healthy activities such as exercise, have healthier dietary habits, and avoid

smoking and alcohol. In this case, random sampling of two groups (taking aspirin and not

taking aspirin) does not remove confounding variables. It will lead to conclusion that

aspirin is effective in preventing stroke, whereas in reality the behavioral and lifestyle

differences that naturally occur between the groups are influencing the results. In this

case, the effectiveness of aspirin is lower in reality. Confounding variables can also affect

the results in the opposite direction. For example, if a group taking aspirin is also prone to

take vitamin supplements that thicken blood (i.e. higher chance of clots and stroke), then

the actual beneficial effects of aspirin may be negated, and a conclusion may be reached

that aspirin is ineffective in stroke prevention.