Medicine and Statistics

^z 11th October 2023 at 8:24am

"Lies, Damned Lies, and Medical Science" is a well-written article by David H. Freedman in this month's The Atlantic magazine. It explains why so much published news about health is dead wrong:

... as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn't really help fend off Alzheimer's disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries. ...

Why the huge error rate? Freedman highlights the work of John P. A. Ioannidis ([1]) whose analysis points out obvious but often-overlooked statistical factors that hit especially hard in modern medicine:

  • smaller studies
  • smaller effect sizes
  • greater number and lesser selection of tested relationships
  • greater flexibility in designs, definitions, outcomes, and analytical modes
  • greater financial and other interests and prejudices
  • hotter topics, with more teams involved

Freedman's article concludes:

We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That's because being wrong in science is fine, and even necessary—;as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that's dressed up to seem more right than it is, scientists will keep delivering exactly that.

"Science is a noble endeavor, but it's also a low-yield endeavor," he says. "I'm not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact."

(cf. Vulnerable Theories (1999-05-17), Altered Native (2002-01-24), Modern Medicine (2005-04-29), Evidence-Based Medicine (2010-01-16), ...) - ^z - 2010-11-13