Quantophrenia in medicine and elsewhere

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Pitirim Sorokin had coined the term to criticize the misapplication of quantitative methods to sociology.  Murray Rothbard borrowed it from Sorokin to describe—in his usual lampooning style—the age-old fascination with mathematical modeling of economic phenomena.  In his Economic Thought Before Adam Smith he points back to Pythagoras to show the influence of number mysticism on the economic thought of Aristotle (who should have known better if we recall the quote from Ethics: “it is the mark of the educated man…”).  The same tendency grips Bacon and Petty who developed ‘political arithmetic’ in the 17th century.  Rothbard also identifies Bernoulli’s founding of ‘mathematical economics’ as leading the way to Walras’ ‘equilibrium theory,’ and so forth.

F.A. Hayek addressed the topic directly in The Counter-Revolution of Science, detailing the origin, thoughts, and influence of the “positivists” buoyed by a transcendent enthusiasm for the exact sciences.  Gilles Paquet recently published a paper titled “Quantophrenia” to review the influence of this form of numerology on public policy.

Emile Durkheim, intellectual heir to Auguste Comte and the positivists, was invoked to shed light on the theories of Geoffrey Rose, our public health maître-à-penser. 

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Why N of 1 is enough…

Against the mega trial with micro effects

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Of all the problems regarding large scale clinical trials cataloged by James Penston, the most compelling is the inverse relationship between practical value and trial size.  This could almost be formulated as a law:

The clinical value of a randomized controlled trial is inversely related to its size

Of course, clinical is used in the original sense, meaning at the bedside.

It is a testimony to the effect of propaganda promoting “powerful” clinical trials that this law may sound counter-intuitive when in fact it is so obvious: if it takes 18,000 patients to demonstrate an effect, how relevant or useful is the information likely to be for a clinician dealing with an individual patient?  And there is now some empirical evidence that the phenomenon of conducting, reporting, and inflating trials with “tiny effects” is getting more and more common.

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The Statistical Alchemy of Meta-Analyses

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A recent post by Dr. Wes reminded me of the remarkable article Alvan Feinstein wrote in 1995 “Meta-Analysis: Statistical Alchemy for the 21st Century.”  In a few clearly written pages, the founding father of clinical epidemiology brilliantly identifies the wishful thinking underlying meta-analysis and exposes its methodological fallacies.

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