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Research Methods · N-of-1 designs

Washout with a one-week half-life: the arithmetic

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SK
s.kimaniTL220 Nov 2024#1
Community wiki post. Any member at trust level 3 or above can edit this post; every edit is recorded. Last edited by PharmNotes_Whitfield on 27 Apr 2025. Editors: crossref_check, PharmNotes_Whitfield

Washout with a one-week half-life: the arithmetic — setting out what I have, and where I think it stops being reliable.

Washout: setting out the arithmetic in full, because I have had to do it twice and I would rather nobody else did.

Every step is shown. If the answer is wrong the error will be visible, which is the point of writing it out rather than posting the result.

51 likes 20mo
T
TavaresTL1Member21 Nov 2024#2

Sample size in n-of-1: you are the sample. Repeated measurements (weekly weighings, daily mood scores) increase the power to detect a real effect even though n=1.

I would want a second opinion before relying on that.

14 likes 20mo
PB
p.boatengTL221 Nov 2024#3
s.kimani, post #1: Washout with a one-week half-life: the arithmetic — setting out what I have, and where I think it stops being reliable. Washout: setting out the arithmetic in full, because I have had to do it twice and I would rather nobody else did. Every step is shown. If the answer is wrong the error will be visible, which is the point of writing it… Go to post

A washout period between conditions is what stops one bleeding into the next, and its length should be set by the half-life rather than by convenience.

5 likes in reply to #1 20mo
LC
l.chevalierTL3Regular22 Nov 2024#4
s.kimani, post #1: Washout with a one-week half-life: the arithmetic — setting out what I have, and where I think it stops being reliable. Washout: setting out the arithmetic in full, because I have had to do it twice and I would rather nobody else did. Every step is shown. If the answer is wrong the error will be visible, which is the point of writing it… Go to post

On washout: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.

0 likes in reply to #1 20mo
SF
s.ferreiraTL222 Nov 2024#5

Coming back to post #3, because the follow-up matters more than the original answer.

The reason washout keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.

20 likes 20mo
CN
c.niemelTL3Regular22 Nov 2024 · edited#6

Post #3 is right about the mechanism and I think understates the practical bit.

A rolling mean over several days is far more informative than any single reading for anything that varies day to day, which is nearly everything.

Scoping that to what I have actually seen rather than what I have read.

9 likes 20mo
RM
r.mwangiTL222 Nov 2024#7

Generalisability: a robust n-of-1 result applies to you. It does not tell you much about whether the effect generalises to others similar to you, much less to people different from you.

Happy to expand any of that if it is the useful part.

2 likes 20mo
B
BramleyTL2Member23 Nov 2024#8
s.kimani, post #1: Washout with a one-week half-life: the arithmetic — setting out what I have, and where I think it stops being reliable. Washout: setting out the arithmetic in full, because I have had to do it twice and I would rather nobody else did. Every step is shown. If the answer is wrong the error will be visible, which is the point of writing it… Go to post

What I would want before treating washout as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing.

0 likes in reply to #1 20mo
TI
t.ibarraTL223 Nov 2024#9

Agreed on washout, with one qualification that I think matters. The reasoning holds for the case as described. Change the starting assumption and it does not, and the starting assumption is the part nobody states.

0 likes 20mo
TN
t.nardoneTL3Regular23 Nov 2024#10
l.chevalier, post #4: On washout: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one. Go to post

Agreed on all of that, and I have nothing to add to it.

27 likes in reply to #4 20mo
FV
f.villalobosTL224 Nov 2024#11

Committing to post the result before you know it is a useful precommitment, and this subcategory is a reasonable place to make it.

The part I am sure of is shorter than the part I have written.

29 likes 20mo
VB
v.baptistaTL224 Nov 2024#12

One caution on washout: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.

0 likes 20mo
BA
b.aaltoTL224 Nov 2024#13
l.chevalier, post #4: On washout: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one. Go to post

A photograph or a device reading is a harder record than a recollection, and where one is available it should be the record.

2 likes in reply to #4 20mo
TP
t.pereiraTL224 Nov 2024#14

I read post #11 twice before replying, because I had assumed the opposite.

Whatever the answer on washout turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.

9 likes 20mo
HF
h.ferrariTL225 Nov 2024#15
EL
e.lehtinenTL225 Nov 2024#16

Washout periods: after stopping a medication, how long does it take for the effect to wash out? For compounds with a week-long half-life, roughly a month is needed to reach baseline. Using that washout period in a before-after design strengthens the inference.

0 likes 20mo
KC
k.chukwuTL225 Nov 2024#17
r.mwangi, post #7: Generalisability: a robust n-of-1 result applies to you. It does not tell you much about whether the effect generalises to others similar to you, much less to people different from you. Happy to expand any of that if it is the useful part. Go to post

Narrowing post #16, because the general version has more than one answer.

Filing a mild objection to the consensus on washout. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.

1 like in reply to #7 20mo
RF
r.friskTL225 Nov 2024#18
f.villalobos, post #11: Committing to post the result before you know it is a useful precommitment, and this subcategory is a reasonable place to make it. The part I am sure of is shorter than the part I have written. Go to post

Everything in post #14 holds. The case it does not cover is the one I have.

Washout was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread.

6 likes in reply to #11 20mo
KK
k.kimaniTL225 Nov 2024#19

Adding the measurement that post #16 says would settle it.

Objective versus subjective measures: subjective measures (how you feel) are vulnerable to bias. Objective measures (weight, strength on a specific exercise) are less vulnerable but not immune.

15 likes 20mo
FF
f.fenwickTL3Regular26 Nov 2024#20

Post #18 describes the usual case. This is about the unusual one.

Careful with the language on washout. "Not detected" and "not present" are different findings and the first is a statement about the method.

30 likes 20mo
SO
s.oyelaranTL226 Nov 2024#21
r.frisk, post #18: Everything in post #14 holds. The case it does not cover is the one I have. Washout was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread. Go to post

Post #19 put the caveat in the right place and I want to underline it.

Two claims get bundled together under washout and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.

Almost every disagreement in threads like this one dissolves once you say which of the two you are making.

0 likes in reply to #18 20mo
M
MJayawardenaTL3Regular26 Nov 2024 · edited#22

Building on post #19 rather than restating it.

Washout periods: after stopping a medication, how long does it take for the effect to wash out? For compounds with a week-long half-life, roughly a month is needed to reach baseline. Using that washout period in a before-after design strengthens the inference.

0 likes 20mo
RC
r.coelhoTL226 Nov 2024#23

I would rather this thread reach "we do not know" about washout than reach a confident answer that nobody can support when asked.

13 likes 20mo
EM
endpoint_marginTL227 Nov 2024#24
TV
to.vargaTL227 Nov 2024#25

Where I part company with post #23, and it is a narrow parting.

It does not tell you about anybody else, which is why aggregating these accounts does not produce evidence of the kind people want it to.

1 like 20mo
CD
cohort_driftTL3Regular27 Nov 2024#26

Multiple outcomes measured without a primary one means something will move. Nominate the primary in advance and report the rest as secondary.

Happy to be corrected if someone holds better data than mine.

0 likes 20mo
IO
i.oseiTL227 Nov 2024#27
t.pereira, post #14: I read post #11 twice before replying, because I had assumed the opposite. Whatever the answer on washout turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction. Go to post

A washout period between conditions is what stops one bleeding into the next, and its length should be set by the half-life rather than by convenience.

It reads as pedantry until the day it does not.

18 likes in reply to #14 20mo
O
OTeixeiraTL3Regular27 Nov 2024#28

Thank you for taking the time. That was more work than a reply usually is.

7 likes 20mo
MO
m.oyelaranTL228 Nov 2024 · edited#29

Stopping rules: decide in advance when you will stop measuring (after a defined duration, after a defined number of measurements, or after a defined condition is met). Not deciding in advance means stopping when the result satisfies you, which is bias.

Not the answer, but possibly the question that gets there.

4 likes 20mo
CI
citation_indexTL2Member28 Nov 2024#30

I disagree with the framing of washout above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

0 likes 20mo