statistics in medicine Archives

The medical fortunetellers

Michel AccadMarch 18, 2016September 10, 2021Medical sciencestatistics in medicine2 Comments

[I’m preparing my paper for the AERC 2016 and have less time for original content, so I thought I would bring to your attention this editorial I wrote a few years ago. I hope you enjoy it. Figure 1 in this article is my most important contribution to empirical science to date!]

There was a time when the foretelling of future events was an undertaking of prophets, palm-readers, and weathermen. In recent years, however, the medical profession seems to have embraced this activity with a great deal of enthusiasm. A prime example is the use of the term “predicts” in the titles of journal articles dealing with human subjects. According to a search of the MEDLINE® database, “predicts” appeared a total of only 13 times before 1980.¹ Since then, however, the occurrence of the term in citation titles has increased dramatically. Expressed as a percentage of the annual number of MEDLINE publications, the trend follows a curve that could be described as hyperbolic (Fig. 1).

Fig. 1. Percentage of MEDLINE® publications on human subjects with the term “predicts” in the title.

[Read the rest here]

Quantophrenia in medicine and elsewhere

Michel AccadJuly 29, 2011December 13, 2016Medical sciencemedical statistics, quantophrenia, statistics, statistics in medicineLeave a comment

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. Continue reading “Quantophrenia in medicine and elsewhere”

Why N of 1 is enough…

Michel AccadJuly 25, 2011December 13, 2016Medical scienceclinical research, clinical trials, medical statistics, randomized clinical trial, randomized controlled trials, statistics, statistics in medicineLeave a comment

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.Continue reading “Why N of 1 is enough…”

The clinical trial on trial

Michel AccadJuly 21, 2011December 13, 2016Medical science, Philosophyclinical trials, randomized clinical trial, statistics, statistics in medicine1 Comment

It is the mark of an educated man to look for precision in each class of things just so far as the nature of the subject admits.

Aristotle

UK gastroenterologist and fellow contrarian James Penston has published two books critical of mainstream clinical research methodology. The most recent one, called Stats.con, deals with the misuse of statistics in medicine and expands on the topic of his first book published in 2003 under the title Fiction and Fantasy in Medical Research: The Large-Scale Randomised Trial.Continue reading “The clinical trial on trial”

The Statistical Alchemy of Meta-Analyses

Michel AccadJuly 11, 2011December 13, 2016Healthcare policy, Medical scienceclinical research, clinical trials, medical statistics, meta-analysis, randomized controlled trials, statistics, statistics in medicine2 Comments

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.Continue reading “The Statistical Alchemy of Meta-Analyses”