Image: Jim Craigmyle / Corbis
In Brief
- Statistical illiteracy is rooted not in intellectual deficits but in the doctor-patient relationship, the illusion of certainty in medicine, and the practice of presenting health information in opaque forms that erroneously suggest big benefits and small harms from interventions.
- Without understanding the numbers, citizens are susceptible to political and commercial manipulation of their anxieties and hopes. The result can be serious damage to physical health and emotional well-being.
- People need to understand the difference between absolute and relative risks and how to use natural frequencies to infer the true chances of disease from a positive test result. Individuals also should know to trust mortality rates over five-year survival statistics when evaluating screening tests.
- To boost statistical literacy, we also recommend introducing young children to statistical thinking and teaching statistics in school as a way of solving real-world predicaments rather than as a purely mathematical discipline.
In a 2007 campaign advertisement, former New York City mayor Rudy Giuliani said, “I had prostate cancer, five, six years ago. My chances of surviving prostate cancer—and thank God, I was cured of it—in the United States? Eighty-two percent. My chances of surviving prostate cancer in England? Only 44 percent under socialized medicine.” Giuliani used these statistics to argue that he was lucky to be living in New York and not in York. This statement was big news. As we will explain, it was also a big mistake.
In 1938 in World Brain (Methuen & Co.), English writer H. G. Wells predicted that for an educated citizenship in a modern democracy, statistical thinking would be as indispensable as reading and writing. At the beginning of the 21st century, nearly everyone living in an industrial society has been taught reading and writing but not statistical thinking—how to understand information about risks and uncertainties in our technological world. That lack of understanding is shared by many physicians, journalists and politicians such as Giuliani who, as a result, spread misconceptions to the public.
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10 Comments
Add CommentI feel that this is a very important article. As a physician it is often difficult to follow through with scientific recommendations. This is in part due to a fear, justified or not, that runs through the medical community that if you do not do everything possible for a patient, no matter how small the benefit, you will be sued. The saying is, "No one is ever sued for over treatment." As acknowledged in the article patients want certainty. They desire to feel that everything that can be done, has been done. This may not be the best physical approach, but it can be mentally assuring to a patient and the family.
Reply | Report Abuse | Link to thisA very good article. Although the authors touched on the subject of drug efficacy I'm surprised they did not invoke the concept of "number needed to treat", or NNT. Basically the number indicates how many people would have to take the drug to reduce bad outcomes by one individual. There is a website with a compilation of NNTs:
Reply | Report Abuse | Link to thishttp://www.medicine.ox.ac.uk/bandolier/band50/b50-8.html
Note the NNT number of 35 for statins in primary prevention of "all bad things." Your doctor may advise you to take this class of drugs if your cholesterol is slightly elevated, but he probably won't tell you that out of 35 persons taking this drug for four years only ONE will actually benefit from it in terms of avoiding a coronary event or other "bad outcome." And keep in mind that the class of people taking the drug may well include patients with VERY elevated cholesterol levels. I wonder how many people with slightly elevated levels would feel this rather minimal risk reduction to be worth the cost and potentially bad side effects of taking this type of drug for the rest of their lives.
There are lies, damn lies and then there are statistics. Statistics can be molded and cited to show any outcome you want and you will not likely to be found out as others will not likely to have access to all of the information. I doubt doctors have the time or inclination to figure out all the facts before giving them to their patients.
Reply | Report Abuse | Link to thisAfter my VA Dr. told me I should take stantins for my slightly elevated cholesterol,I studied up on the subject and decided to lose a few pounds and have boiled oatmeal for breakfast, the side effects of stantins were too high a risk.
Wikipedia States 900,000 people get stomach cancer every year 800,000 die from it every year I was diagnosed with stomach cancer 7 years ago I refused the treatment they wanted me to have (remove stomach) They refused the treatment I wanted (just remove the cancer)so I have received no treatment yet I still live.Am I a freak?or is their treatment not what it is cracked up to be?
Reply | Report Abuse | Link to this@octoman:
Reply | Report Abuse | Link to thisThe longer you live, the greater chance you'll survive your cancer. It's one of those things about probability and statistics that actually works in your favor!
Useful and important article, slightly tainted by a mistake in the breast cancer discussion that shows us that even the author's knowledge of math is not at 100%: "Only 21 percent of physicians picked the best answerone out of 10."
Reply | Report Abuse | Link to this(Not two out of 10?)
A dissertation on "Adverse Drug Reactions: The Hidden Drug Abuse" pointed out that every single Pharmaceutical, PMA, business has been brought up and charged with, at the very least, falsifying research and fraudulent work in relation to securing FDA approval over the years. Since; successfully pressuring hardline republicans to create a fast track process for FDA approval of new drugs, the waging a war of with obfuscation and subterfuge on the average intelligent and well-meaning doctor, and since trying to increase subordinate and client pressure directly on the doctors through ads directing patients to pressure their doctors, nothing has changed in the business conduct, moral ineptitutde, and greed of the PMA under the guise of protecting human decency, increasing human comfort and diminishing human suffering.
Reply | Report Abuse | Link to thisBe well advise I will actively promote cases to ensure lackidaisical and less than diligent efforts by doctors hiding behind precriptions as an excuse to ease their own guilt from laziness ("doing everything possible"), will be brought forward for prescribing crap to patients.
I would use such remedies only if a patient were highly susceptible to suggestion or placebo effect.
A dissertation on "Adverse Drug Reactions: The Hidden Drug Abuse" pointed out that every single Pharmaceutical, PMA, business has been brought up and charged with, at the very least, falsifying research and fraudulent work in relation to securing FDA approval over the years. Since; successfully pressuring hardline republicans to create a fast track process for FDA approval of new drugs, the waging a war of with obfuscation and subterfuge on the average intelligent and well-meaning doctor, and since trying to increase subordinate and client pressure directly on the doctors through ads directing patients to pressure their doctors, nothing has changed in the business conduct, moral ineptitutde, and greed of the PMA under the guise of protecting human decency, increasing human comfort and diminishing human suffering.
Reply | Report Abuse | Link to thisBe well advise I will actively promote cases to ensure lackidaisical and less than diligent efforts by doctors hiding behind precriptions as an excuse to ease their own guilt from laziness ("doing everything possible"), will be brought forward for prescribing crap to patients.
I would use such remedies only if a patient were highly susceptible to suggestion or placebo effect.
A dissertation on "Adverse Drug Reactions: The Hidden Drug Abuse" pointed out that every single Pharmaceutical, PMA, business has been brought up and charged with, at the very least, falsifying research and fraudulent work in relation to securing FDA approval over the years. Since; successfully pressuring hardline republicans to create a fast track process for FDA approval of new drugs, the waging a war of with obfuscation and subterfuge on the average intelligent and well-meaning doctor, and since trying to increase subordinate and client pressure directly on the doctors through ads directing patients to pressure their doctors, nothing has changed in the business conduct, moral ineptitutde, and greed of the PMA under the guise of protecting human decency, increasing human comfort and diminishing human suffering.
Reply | Report Abuse | Link to thisBe well advise I will actively promote cases to ensure lackidaisical and less than diligent efforts by doctors hiding behind precriptions as an excuse to ease their own guilt from laziness ("doing everything possible"), will be brought forward for prescribing crap to patients.
I would use such remedies only if a patient were highly susceptible to suggestion or placebo effect.
Devils,
Reply | Report Abuse | Link to thisI would be interested in hearing more about this dissertation. Will you please contact me? My email is mariangreene04 at yahoo.com. I have an issue you may be interested in.