Описание
Preface
Medicine without statistics is quackery; statistics without medicine is numerology. Perhaps
this is the main reason why clinicians should care about statistics.
Statistics in medicine began in the early nineteenth century (it was called “the numerical
method” then) and its debut involved disproving the most common and widely accepted
medical treatment for millennia: bleeding. From ancient Rome until 1900, all physicians –
from Galen to Avicenna to Benjamin Rush – strongly and clearly advocated bleeding as the
treatment for most medical illnesses. This was based on a theory, most clearly defined by
Galen: four humors in the body, if out of balance, led to disease; bleeding rebalanced the
humors.
Of course this was all wrong. Even the dullest physician today would know better. How
was it disproven?
Statistics.
Pierre Louis, the founder of the numerical method, counted 40 patients with pneumonia
treated with bleeding and showed that the more they were treated, the sooner they died.
Bleeding did not treat pneumonia, it worsened it (Louis, 1835).
Counting – that was the essence of the numerical method; and it remains the essence of
statistics. If you can count, you can understand statistics. And if you can’t (or won’t) count,
you should not treat patients.
Simply counting patients showed that the vaunted experience of the great medical
geniuses of the past was all for nought. And if Galen and Avicenna could be mistaken, so
can you.
The essence of the need for medical statistics is that you cannot count on your own experience, you cannot believe your eyes, you cannot simply practice medicine based on what you
think you observe. If you do this, you are practicing pre-nineteenth century, prescientific,
prestatistical medicine.
The bleeding of today, in other words, could well be the Prozac or the psychotherapy
that so many of us mental health clinicians prescribe. We should not do things just because
everyone else is doing it, or because our teachers told us so. In medicine, the life and death of
our patients hang in the balance; we need better reasons for preserving life, or causing death,
than simply opinion: we need facts, science ... statistics.
Clinicians need statistics, then, to practice scientifically and ethically. The problem is that
many, if not most, doctors and clinicians, though trained in biology and anatomy, fear numbers; mathematics is foreign to them, statistics alien.
There is no way around it though; without counting, medicine is not scientific. So how
can we get around this fear and begin to teach statistics to clinicians?
I find that clinicians whom I meet in the course of lectures, primarily about psychopharmacology, crave this kind of framing of how to read and analyze research studies. Residents
and students also are rarely and only minimally exposed to such ideas in training, and, in the
course of journal club experiences, I find that they clearly benefit from a systematic exposition of how to assess evidence. Many of the confusing interpretations heard by clinicians are
due to their own inability to critically read the literature. They are aware of this fact, but are
unable to understand standard statistical texts. They need a book that simply describes what
Детали
- Год издания
- 2009
- Format
