bioRxiv2020
Multimodal diseases are those in which affected individuals can be divided into subtypes (or data modes); for instance, mild vs. severe, based on (unknown) modifiers of disease severity. Studies have shown that despite the inclusion of a large number of subjects, the causal role of the microbiome in human diseases remains uncertain. The role of the microbiome in multimodal diseases has been studied in animals; however, findings are often deemed irreproducible, or unreasonably biased, with pathogenic roles in 95% of reports. As a solution to repeatability, investigators have been told to seek funds to increase the number of human-microbiome donors (N) to increase the reproducibility of animal studies (doi:10.1016/j.cell.2019.12.025). Herein, through simulations, we illustrate that increasing N will not uniformly/universally enable the identification of consistent statistical differences (patterns of analytical irreproducibility), due to random sampling from a population with ample variability in disease and the presence of disease data subtypes (or modes). We also found that studies do not use cluster statistics when needed (97.4%, 37/38, 95%CI=86.5,99.5), and that scientists who increased N, concurrently reduced the number of mice/donor (y=-0.21x, R2=0.24; and vice versa), indicating that statistically, scientists replace the disease variance in mice by the variance of human disease. Instead of assuming that increasing N will solve reproducibility and identify clinically-predictive findings on causality, we propose the visualization of data distribution using kernel-density-violin plots (rarely used in rodent studies; 0%, 0/38, 95%CI=6.9e-18,9.1) to identify disease data subtypes to self-correct, guide and promote the personalized investigation of disease subtype mechanisms. HighlightsO_LIMultimodal diseases are those in which affected individuals can be divided into subtypes (or data modes); for instance, mild vs. severe, based on (unknown) modifiers of disease severity. C_LIO_LIThe role of the microbiome in multimodal diseases has been studied in animals; however, findings are often deemed irreproducible, or unreasonably biased, with pathogenic roles in 95% of reports. C_LIO_LIAs a solution to repeatably, investigators have been told to seek funds to increase the number of human-microbiome donors (N) to increase the reproducibility of animal studies. C_LIO_LIHerein, we illustrate that although increasing N could help identify statistical effects (patterns of analytical irreproducibility), clinically-relevant information will not always be identified. C_LIO_LIDepending on which diseases need to be compared, random sampling alone leads to reproducible patterns of analytical irreproducibility in multimodal disease simulations. C_LIO_LIInstead of solely increasing N, we illustrate how disease multimodality could be understood, visualized and used to guide the study of diseases by selecting and focusing on disease modes. C_LI